Surprise billing occurs when patients receive care from out-of-network providers without their knowledge. On July 1, the Biden Administration passed an interim final rule: the
In my view, the latest change to this guideline is the best so far. The current definition of the root operation Control is “stopping, or
EDITOR’S NOTE: Colleen Deighan will be conducting a Talk Ten Tuesdays Listener Survey on CDI today. When you read these words, “outpatient CDI,” what comes
Sadly, this is a crisis of our own making. Remember early on in the pandemic, when we used the expression “flatten the curve” when referring
The CDC recommends healthcare workers get one dose of influenza vaccine annually. The Centers for Disease Control and Prevention (CDC) has many more vaccines it
Those who suffer from post-acute sequelae of SARS-CoV-2 infection, are referred to as long haulers. When COVID-19 swept across the county in late 2019 early
Comments on the PCS proposals may be emailed to [email protected] by Oct. 15 for codes considered for implementation on April 1, 2022. The Coordination and
Stigmatizing language should be avoided whenever possible. I read an article in the Journal of the American Medical Association (JAMA) a few weeks ago that
Rationing of patient care: everything is different, but nothing has changed. EDITOR’S NOTE: Crisis Standard of Care, first reported here on RACmonitor, occurred in the
An unvaccinated individual is 10 times more likely to be hospitalized with COVID-19; 11 times more likely to die from it. EDITOR’S NOTE: This article
Coordination and Maintenance committee meeting remains virtual. The Coordination and Maintenance Committee meeting is scheduled for today, Sept. 14, and continues through Sept. 15. As
Provider uncertainty appears to be hampering participation in this program. There are still some providers that are unsure how to participate in and bill for
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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