Chronic conditions are the driving force in determining healthcare outcomes and costs in today’s value-based world, hence the interest in the Hierarchical Condition Category (HCC)
Answers to listeners’ questions posed during last week’s edition of Talk Ten Tuesdays are provided here by the author. There is a disconnect among coders
Understanding when and how to use clinical documentation integrity internal clinical guidelines (CDI-ICGs) Clinical policies, clinical practice guidelines, best practice advice: there are numerous ways
Healthcare quality and data come from clinical documentation. Bricks and mortar are the foundation of many a structure. Clinical documentation and coding are similar, as
Unfortunately, the quality of data is driven less by opportunity and more by incentives for those creating the data. Prior to the implementation of ICD-10,
CTE is coded as postconcussional syndrome which is F07.81 January 30th is National CTE Awareness Day according to www.stopcte.org. This organization was founded by the
CDI programs are viewed by most physicians as hospital-led initiatives geared towards increasing reimbursement for the hospital.The majority of clinical documentation improvement (CDI) programs fail
Medical policies are based off of evidence-based medicine. Without proper documentation, however, most providers struggle to get services or procedures covered for patients. Exactly what
For HIM and CDI professionals, 2018 looks to offer a gift of the tremendous opportunity for success. For movie buffs, the film Darkest Hour offers
CDI, used to clearly communicate the clinical status of a patient, comes with the increased scrutiny of third-party payers and federal oversight agencies. EDITOR’S NOTE:
Hospital services must positively contribute to the revenue cycle and clinical documentation integrity initiatives. A recent outlook report released by Moody’s Investors Services spells continued
Leaving 2017 and moving into 2018, three major issues await coders—issues that could be opportunities. As we now come to the end of another year
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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