In 2019, I had an employee health exam, and fortuitously but startlingly discovered I had no sight in my left eye. I rushed my butt
The Centers for Medicare & Medicaid Services (CMS) has announced the establishment of the Wasteful and Inappropriate Services Elimination and Reduction (WISeR) Model, a six-year
I’d like to begin with a thank-you to Dr. Stephanie Van Zandt, Medical Director of Physician Advisor Services at BayCare, for sharing this news. The
Last week during the ICD10monitor’s IPPSpalooza, we reviewed changes to the Inpatient Prospective Payment System (IPPS). The updates to IPPS are effective Oct. 1, 2024.
As we begin the second half of the year, it is a convenient time to make plans and take stock of our coding operations. There
Although the effective date for billing Office and Outpatient (O/O) Evaluation and Management (E&M ) Visit Complexity Add-on Code G2211 was Jan. 1, the Centers
If your laboratory performs toxicology procedures to test for drugs of abuse, you have most likely become aware of the new Procedure-to-Procedure (PTP) edits effective
Late physician signatures pose serious issues. In the last few months, I have had questions about late signatures on documentation come in from several clients.
In search of good collaboration among stakeholders. For many years I’ve been surprised at the various levels of disagreement between staff involving both outpatient and
CMS provides updates and insight during the HBMA meeting. The Healthcare Business Management Association’s (HBMA) Government Relations Committee has been extremely fortunate to be invited
“Medical necessity” is a much-used but often-misunderstood concept. After our recent four-part series on the “Pitfalls of an Audit” and our last Talk Ten Tuesdays
Frustrations arise over inconsistent guidance from MACs and CMS. Every single day, I get numerous email notices from the Centers for Medicare & Medicaid Services
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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