The IPPS proposed rule is dense reading. The Centers for Medicare & Medicaid Services (CMS) released its Inpatient Prospective Payment System (IPPS) Proposed Rule for
It’s about time. I talked about the medical decision-making element regarding the updated 2021 Office and Ambulatory Services Evaluation and Management (E&M) Guidelines a few
The sequester is expected to end next year in the absence of any legislation. Times change – there was a time when deficit spending caps
The patient story is paramount to validating a diagnosis of sepsis. MS-DRGs 872 and 871, Septicemia or Severe Sepsis with MCC and without MCC, respectively,
We need to stop thinking of it as copying and pasting, and have a paradigm shift to consider it copying and editing. Last week, Shannon
A reader says that coders, not CDISs, are querying physicians. Across the archipelago of the Internet came a timid yelp to be heard one recent
Revenue is not a goal; it is an outcome. Healthcare providers, hospitals and other services, have struggled for the last decade to maintain sustainable revenue
To query or not query that is the question. Querying is the lifeline of clinical documentation integrity (CDI) professionals and many coding professionals. In fact,
Updates are retroactive to Jan. 1, 2021. The following updates have been made via American Medical Association/Current Procedural Terminology (AMA/CPT®) editorial corrections. These corrections (errata)
In January 2021, the billing guidelines changed for office and outpatient-based ambulatory services. During my interview with the C-suite occupants for my physician advisor job,
CMS says the proposed rule is intended to enhance medical workforce in rural and underserved communities. Long-awaited and eagerly anticipated the Centers for Medicare &
Comments on these proposed rules are due by June 7. Hospice payment rates, as well as those for skilled nursing facilities (SNFs), constitute the subjects
CMS CRUSH (Comprehensive Regulations to Uncover Suspicious Healthcare) signals a new era of data-driven program integrity oversight that extends far beyond coding and CDI. As federal scrutiny of claims, documentation, billing practices, provider enrollment, and payment accuracy intensifies, healthcare organizations must be prepared to identify and address vulnerabilities before they result in audits, denials, repayments, or enforcement actions. Join us for this timely webcast to learn what CMS CRUSH could mean for your organization and discover practical strategies to strengthen documentation, claims integrity, compliance readiness, and reimbursement defensibility.
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.
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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