The “economic burden” of prescription opioid misuse is nearly $80 million. We were discussing opioid dependence in my CDI education session last week and it
AI-powered solutions must align with applicable coding guidelines. Electronic health records (EHRs), clinical documentation software, and enabling technologies are working together in new and exciting
Semantics aside, clinicians must recognize sepsis and treat it aggressively, to save lives. A few weeks ago, I had a fascinating discussion with Tim Brundage,
As the provision of healthcare changes, so too must clinical documentation improvement. I have always been convinced of the strong capabilities of current clinical documentation
These conditions should be on the radar for coding and clinical documentation integrity. There has been much discussion about healthcare expenses in recent months. The
Prime Healthcare lawsuit reveals a huge risk for unethical practice. A few weeks ago, Dr. Ronald Hirsch brought to my attention (as is his custom)
Coding of chronic conditions: Part 2 This article addresses concerns regarding the coding of chronic conditions during a patient’s journey. The truth of the matter
The goal should be a 100 percent response rate. On a recent onsite, one of the clinical documentation integrity specialists (CDISs) asked me my opinion
Developing a team approach can positively impact coding quality and reduce coding errors. Coding professionals are faced with a myriad of challenges that can significantly
CDI professionals can’t mitigate the magnitude of medical necessity denials by third-party payers. Clinical documentation integrity (CDI) programs, combined with the actions of third-party payers,
Coders need to know when and how the cardiac arrest occurred. There are approximately 350,000-400,000 cases of cardiac arrest arising outside of the hospital setting
The accurate diagnosis of sepsis is not for DRG assignment. There has been quite a bit of controversy stirred up by UnitedHealthcare (UHC) and its
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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