The Centers for Medicare & Medicaid Services (CMS) has released updated instructions for the Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131, extending the form’s
I had planned a different topic for this week, sequencing sepsis, based on feedback from my last article, but an article about OpenEvidence rolling out
EDITOR’S NOTE: The author of this article used artificial intelligence (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the
March is National Colorectal Cancer Awareness Month, a good time to take a look at warning signs and concerns related to the disease, which is
The articles describe a significant 2026 dispute over the misuse of health information exchanged by asserting a treatment purpose through Carequality. (Raths) The core allegation
EDITOR’S NOTE: The author of this article used artificial intelligence (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the
A common debate among clinical documentation integrity (CDI) professionals, physician advisors, and coders is what to sequence as the principal diagnosis when a patient arrives
It’s hard to believe, but April 1 is right around the corner. As coders, we know that is one of our update dates, and this
A current movement within the clinical revenue cycle is putting utilization review and clinical documentation integrity (CDI) under the same reporting structure. There are many
Last week MedLearn Media published an article by Bryan Nordley titled “Defend Against IR Dialysis Circuit Denials: Expert Coding Tips to Promote Success in 2026.”
EDITOR’S NOTE: The author of this article used AI-assisted tools in its composition, but all content, analysis, and conclusions were based on the author’s professional
This week Blue Cross Blue Shield published an article titled “Study suggests AI is boosting hospital billing.” The study was based on data analyzed by
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.
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.
Master the FY 2027 ICD-10-CM changes, including new diagnosis codes, CC/MCC updates, and coding guideline revisions, with practical insights from nationally recognized coding and CDI experts.
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