Let me start with a recently published audit of a home care agency, Sunflower Home Health in Cleveland Mississippi. During a two-year audit period, the
Today, in utilization news, there is a warning to any surgeons who may be reading this – or anyone who works with surgeons. You may
Over the past few months, a number of my articles have covered a combination of social injustices and oddities from federal agencies. In this article,
Following all the rules can be complicated. And sadly, following all the rules is not optional. Mary Inman frequently reports here on the consequences of
For all of the Monitor Monday listeners who tuned in to the April 21 airing1 or read my April 23 RACmonitor post titled “Weaponizing the
As we often notice when new leadership takes over at a federal agency, there is seemingly nonstop news from the Centers for Medicare & Medicaid
What should you do if you get an email with the subject line “U.S. Office of Inspector General HHS – Special Investigations?” A doctor I’m
Let me start with a wild Medicare Advantage (MA) denial of inpatient admission. This was a 75-year-old male who fell. The patent had chronic atrial
EDITOR’S NOTE: Following last Monday’s Monitor Monday Internet broadcast, the U.S. Department of Health & Human Services (HHS) posted new guidance and an online portal,
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) recently released a concerning audit report revealing widespread compliance
EDITOR’S NOTE: Senior healthcare consultant Cheryl Ericson reported this story live today during Monitor Mondays. Ericson is the director of clinical documentation integrity (CDI) and
When they came for the watchdogs, they did so in the middle of the night. As many as 18 Inspectors General of various federal agencies,
Medicare regulations are complex and even seasoned professionals struggle to apply them consistently. Due to overwhelming demand, Dr. Hirsch returns for Part 2 of Ask Dr. Hirsch: Clarifying Medicare’s Most Misunderstood Rules to answer even more of Medicare’s most misunderstood questions, covering inpatient status, observation, SNF access, Medicare Advantage denials, and more. Join Dr. Hirsch as he provides clear, referenced answers to real-world questions submitted by your peers, helping you navigate Medicare compliance with confidence and clarity.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Artificial intelligence is rapidly transforming healthcare revenue cycle operations, from coding and auditing to compliance and denials. Join industry leaders Pam Warren (MaineHealth) and Raemarie Jimenez (AAPC) for a live fireside chat exploring how AI is changing workflows, workforce roles, payer-provider dynamics, and compliance risk—and what organizations should be doing now to prepare.
Prepare for FY 2027 IPPS changes with a comprehensive 3-part masterclass covering ICD-10-CM/PCS updates, MS-DRG shifts, NTAPs, compliance risks, and reimbursement strategies.
Stay ahead of FY 2027 reimbursement changes with expert analysis of MS-DRG shifts, NTAP updates, Medicare Code Edits, and emerging technologies impacting inpatient payment accuracy.
Stay ahead of FY 2027 ICD-10-PCS changes with expert analysis of new procedure codes, revised guidelines, and high-impact updates affecting reimbursement, compliance, and inpatient coding accuracy.
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