Creating industry guidance is a challenging task. It is often difficult to remove ambiguity that could lead to unintended interpretations. I think the contributors to
EDITOR’S NOTE: The author of this article used artificial intelligence (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the
I am not a proponent of measuring the impact of clinical documentation integrity (CDI) departments by case mix index (CMI) or complication/comorbidity capture rates (CCs/MCCs).
The articles describe a significant 2026 dispute over the misuse of health information exchanged by asserting a treatment purpose through Carequality. (Raths) The core allegation
In the complex world of healthcare, language is everything – not just in bedside communication, but in the precise documentation that informs coding, billing, compliance,
I recently mentioned that some facilities are receiving payer denials through which a reportable, clinically valid, documented diagnosis is removed from a claim because the
Last week I mused about how clinical validation queries do not appear to be keeping up with the volume of clinical validation denials. Perhaps one
Clinical validation queries have been recommended for almost a decade, yet many clinical documentation integrity (CDI) and coding professionals continue to struggle with crafting these
EDITOR’S NOTE: Dr. Erica Remer was, for nearly seven years, the cohost with Chuck Buck on Talk Ten Tuesday and a member of the ICD10monitor
When I ask facilities what their most common denials are, invariably, pneumonia makes the list. That was my personal experience when I handled clinical validation
Is your hospital receiving a high volume of clinical validation denials? If so, you’re not alone. Clinical validation denials continue to grow in volume
Clinical validation is a bit of a misnomer. However, I am going to consider clinical validation as the act of questioning. Last week, I participated
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.
This Memorial Day, we honor those who gave all for our freedom. Take 20% off sitewide through May 29 with code MEMORIAL26 at checkout
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
