Generative artificial intelligence (AI) is reshaping health information management (HIM) at a pace few anticipated. Hospitals and health systems are integrating large language models (LLMs)
Among the many responsibilities of hospital case managers, none is more critical or more impactful than the initial discharge planning evaluation. Often referred to as
Is your hospital ready for hybrid measures? Many clinical documentation integrity (CDI) departments have incorporated Centers for Medicare & Medicaid Services (CMS) quality measures into
“PAYGO” (Pay-As-You-Go) refers to a budget enforcement rule designed to impose fiscal discipline: when lawmakers pass legislation that increases mandatory spending or reduces revenue without
When a patient leaves the hospital against medical advice (AMA), the discharge is not only a clinical concern, but it can also create coding and
Someone recently asked on LinkedIn if they must always sequent a UTI as the principal diagnosis when encephalopathy due to a urinary tract infection (UTI)
September is the annual Suicide Prevention Month which is also a reminder to examine our coding considerations. In March of this year, the Centers for
Mandatory vs. discretionary spending Antideficiency Act “exceptions” Under the Antideficiency Act (which prohibits federal agencies from incurring obligations without appropriations), there are certain exceptions that
This week, as we continue to explore querying for acute (metabolic or toxic) encephalopathy, I want to examine the Glasgow Coma Scale (GCS) as a
I think many have heard me discuss a common scenario with which hospitals are grappling: patients who are medically ready for discharge, but have no
Healthcare compliance professionals have long wrestled with the problem of copied-and-pasted notes in medical charts. When clinicians copy-forward prior entries or borrow from templates, auditors
A few weeks ago, I shared some information about Risk Adjustment Data Validation (RADV) coding audits. I mentioned the increased number of audits, and the
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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