EDITOR’S NOTE: This article marks the second installment in a two-part series centering on the CMS Physician Fee Schedule proposed ruling, as it pertains to
I thought it would be helpful to discuss over the next couple of weeks the Medicare Physician Fee Schedule (PFS) for the 2024 calendar year
This week, STAT News published an interesting series on a report released in 2003 by the National Academies Press, titled Unequal Treatment: Confronting Racial and
Let’s begin by defining the two key elements of this topic. Social Determinants of Health (SDOH), as established by the World Health Organization, are the
There are several new adjustments to the SDoH codes Z55- Z65 in the 2024 ICD-10-CM that are worth reporting. I am going to focus
A regular comment I hear from hospitalist medicine and case management staff is “we are waiting on the PT consult” or “we are waiting for
The program will begin in eight states. How do you make primary care better? Why, by making care primary, of course. Such was clearly the
In my recent hospital travels, involving working with frontline case management staff, we completed an initial assessment and intervened with a patient who provides one
Last week, the chief medical officer (CMO) for the Centers for Medicare & Medicaid Services (CMS), Dora Hughes, MD, MPH, published a blog in Health
A recent Journal of the American Medical Association (JAMA) article (Ryan, J., et.al, 2023) provided some compelling evidence for the confirmation that our hospitalized patients
This week and next, I plan to expand on thoughts about the 2024 Inpatient Prospective Payment System (IPPS) rule regarding health equity and the social
Delays in transitions to post-acute care are a vexing issue. I am continuing to see a significant number of healthcare organizations dealing with denials and
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
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