Is the membership of PHARMA.org made up almost exclusively by companies that sell high priced drugs and devices? Unless you live under a rock, you
CMS has published a booklet on this procedure. Recently I was asked to assist with an audit that was to focus on clinical documentation for
Can you survive an OIG Audit? When the Public Health Emergency (PHE) was extended for the 10th time on July 15, 2022, continuing the PHE
Facing the issue of admitting privileges. Recently I became the physician advisor for a critical access hospital, Cameron Memorial Community Memorial Hospital in Angola, Ind.
Medicare post-payment audits are estimated to have risen over 900 percent over the last five years. Let’s talk about post-payment audits – or, specifically, Recovery
Providers need to stay alert as to the areas being targeted for review by federally contracted entities. Medicare Part A covers, among other things, inpatient
An examination of areas of focus to reduce wasteful healthcare spending on services with little to no clinical benefit, and finding opportunities in improving the
This program could be a windfall for accountants, but also a huge bottleneck. The Provider Relief Fund (PRF) became law as part of the Coronavirus
Coding audits provide insight into the process of coding itself. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has
The hiatus of audits was short-lived. The ongoing COVID-19 pandemic and resulting public health emergency (PHE) has brought about massive and quick changes in the
As payors both in government (Medicare) and the commercial arena (private plans) see the recoupment rate of services billed incorrectly or non-compliantly skyrocket, the payor
CORRECTION: This story has been corrected. There was no Meaningful Use Act. The American Reinvestment & Recovery Act (ARRA) was enacted on Feb. 17, 2009. ARRA included
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
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