The recent study was commissioned by the American Hospital Association and the Federation of American Hospitals. A report released last week found that the federal
Medicare Advantage plans have reacted to industry criticism of their limited coverage expansion of SdoH. I expected a buzz over our recent Monitor Mondays report
Providers are encouraged to file protective appeals. “In section XI of the preamble of the proposed rule, we discussed the growing number of Provider Reimbursement
President Trump issues an executive order on kidney disease and a new payment model for radiation therapy. As reported by Dr. Ronald Hirsch on the
Coding Guidelines and Conventions trump Coding Clinic. Hats off to coders. This group of medical information professionals is required to master one of the most
HHS ordered back to the drawing board – and told to work quickly. A federal judge has upheld a lower court’s ruling that the U.S.
Could recoupments be unconstitutional? Case law is changing in favor of healthcare providers who accept Medicare and/or Medicaid. Without question, accepting Medicare and/or Medicaid payments
Keeping patients in LTACHs longer than necessary can increase reimbursement. Two years ago, on Monitor Mondays and in the RACmonitor eNews, Ronald Hirsch, MD told
THIS STORY HAS CORRECTED TO REFLECT THE NOV. 2 RELEASE OF THE FINAL FOR 2019 EDITOR’S NOTE: CMS on Thursday released the 2019 Medicare Physician
This question can help you evaluate lawyers EDITOR’S NOTE: This is the second and final installment in a two-part series as to when facilities should
A proposed 50 percent reduction in claims submitted with modifier 25 is on the table. The Centers for Medicare & Medicaid Services (CMS) is proposing
Major overhaul to physician reimbursement is proposed. The Centers for Medicare & Medicaid Services (CMS) revealed the proposed rule for Medicare Physician Fee Schedule (MPFS),
Stay ahead of Medicare Advantage’s 2025-2026 regulatory changes in this critical webcast featuring expert Tiffany Ferguson, LMSW, CMAC, ACM. Learn how new CMS rules limit MA plan denials, protect hospitals from retroactive claim reopenings, and modify Two-Midnight Rule enforcement—plus key insights on omitted SDoH mandates and heightened readmission scrutiny. Discover actionable strategies to safeguard revenue, ensure compliance, and adapt to evolving health equity priorities before the June 2025 deadline. Essential for hospitals, revenue cycle teams, and compliance professionals navigating MA’s shifting landscape.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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