External audit volume more than doubled in 2024 over 2023, while total at-risk dollars increased fivefold to $11.2 million, according to a report outlining a
As a provider, a question worth asking yourself these days is this: what degree of risk is there that you might have something on your
There has been a lot of recent chatter about the applicability of the Two-Midnight Rule to Medicare Advantage (MA) plans. If ever there was rampant
An oncology practice I work with recently called with a challenging question: what do we do with a patient who acted in a threatening manner?
HCC scores also don’t predict costs (or payments). EDITOR’S NOTE: This is the second and final article in a two-part series about Hierarchical Condition Category
Important advice when dealing the media. Because the federal government and health insurers are covering the cost of the COVID-19 vaccine and its administration, it
MAOs use chart reviews to increase risk-adjusted payments is seen as inappropriate by the OIG. The U.S. Department of Health and Human Services (HHS) Office
The whistleblower brought this suit under the federal False Claims Act. In February 2014, whistleblower Sarah Benhke, the former senior Medicare Part D actuary at
New Z codes also aimed at reducing hospital readmissions. The one thing that medicine does not have enough of is abbreviations. So allow me to
Most compliance decisions involve balancing risk. EDITOR’S NOTE: The following is a summary of a recent broadcast segment on Monitor Monday by the author. Generally
There is no need to worry about coding for HCCs or risk adjustment, writes the author. Just follow the coding guidelines. Confusion abounds regarding the
“Ghost” guidance must be identified – even on government sites. Using the Internet is often a risky business. Phishing attacks or hacking may immediately come
Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.
Fraud convictions don’t just punish a few bad claims; they can wipe out years of reimbursements. Don’t wait for an audit to learn the rules. Join Frank Cohen, MPA, for a live Q&A on spotting red flags, avoiding liability, and protecting your practice. Register now and bring your questions!
Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025. Register today and be a part of the conversation!
Vaccine policies, billing rules, and compliance risks are changing fast! How will your organization adapt? Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating new Medicare mandates, coding updates, and legal challenges in vaccination programs. Get expert answers on billing, compliance, outbreak risks, and operational strategies to protect your facility and patients. . Join us live and bring your questions to the table.
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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