To think that queries and increased case mix index (CMI) is the end-all and be-all of CDI is a fallacy. In a recent conversation with
The idea that CMI can continue to increase year over year as a result of improved documentation and coding accuracy is likely misguided. An important
In many ways, CDI is the perpetuator of self-inflicted denials through the query process. Unprecedented times require unprecedented actions, with all hospitals and health systems
The practice of medicine takes clinical criteria into consideration, but clinical judgment can override criteria. As I was deleting emails one morning, I saw a
In my first article of this series, I outlined how most clinical documentation integrity (CDI) programs began in response to either the creation of the
The CDI profession has failed to effectively articulate its value in the revenue cycle. Role-based versus task-based business processes can play a major role in
EDITOR’S NOTE: This is the first installment of a four-part series that explores the past, present and future of clinical documentation integrity (CDI). To understand
The CDI profession has failed to effectively articulate its value in the revenue cycle. An American Hospital Association (AHA) report released June 30 finds that the financial
One billion dollars is a big number, but more astounding to me, as it pertains to a recent finding by the U.S. Department of Health
Outpatient clinical documentation improvement (CDI) programs have moved into the mainstream, as hospitals and healthcare systems continue to embrace consulting companies’ push into the outpatient
I conceived a new project that triggered last week’s TalkBack segment on the Talk Ten Tuesdays weekly Internet radio broadcast, and I would love your
Capturing the complexity of care with CDI will be more important than ever. The COVID-19 pandemic is “hot-spotting” in places like New York City, New
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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