Radiology reports are rich with clinical detail—abnormalities, precise anatomy, and incidental findings—but that level of detail doesn’t always translate cleanly into ICD-10 coding. In my
Custodial or social hospitalizations have been a long-standing issue within acute care hospitals. These patients generally arrive to the Emergency Department (ED) with vague or
A recent qualitative study published in the Journal of the American Medical Association (JAMA) Network Open explored the implementation of social determinants of health (SDoH)
You have heard Dr. Ronald Hirsch, and I present on CMS-4204-F which introduces a process for expedited determinations for traditional Medicare beneficiaries who are reclassified
EDITOR’S NOTE: This article updates the final ruling that was initially reported on by Ronald Hirsch, MD in January 2024. CMS Proposes New Appeal Process
There seem to be variances, particularly regionally, regarding the use of the preadmission Hospital-Issued Notice of Non-coverage (HINN) and the Advance Beneficiary Notice of Non-coverage
The implementation of outpatient in a bed (OPIB) classifications in hospital settings presents unique challenges, particularly regarding billing, patient care, and regulatory compliance. These challenges
As part of the Jan. 1, 2024 Outpatient Prospective Payment System (OPPS) guidelines, caregiver training services (CTS) codes were listed as billable services if provided
Last week I wrote about when surgery should be performed as an inpatient, when it can be outpatient, and how to utilize observation services in
The Centers for Medicare & Medicaid Services (CMS) has proposed a significant new development in the 2024 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical
Is this a familiar scenario to you? Patients come to the ED, although some do not even need an ED level of care. Some do,
The AMA updated consultation services for 2023. EDITOR’S NOTE: The American Medical Association (AMA) announced major revisions to Evaluation and Management (E&M) Services for Jan
Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.
Fraud convictions don’t just punish a few bad claims; they can wipe out years of reimbursements. Don’t wait for an audit to learn the rules. Join Frank Cohen, MPA, for a live Q&A on spotting red flags, avoiding liability, and protecting your practice. Register now and bring your questions!
Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025. Register today and be a part of the conversation!
Vaccine policies, billing rules, and compliance risks are changing fast! How will your organization adapt? Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating new Medicare mandates, coding updates, and legal challenges in vaccination programs. Get expert answers on billing, compliance, outbreak risks, and operational strategies to protect your facility and patients. . Join us live and bring your questions to the table.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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