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Claims

When Inpatient Claims Are Impacted by Outpatient Services

This week, let’s focus on coding guidelines associated with reporting diagnoses occurring during an outpatient visit subject to the Medicare Three-Day Payment Window Rule. Remember, the inpatient hospital claim must include all the diagnosis and procedure codes that meet the Three-Day Payment Window requirements. Therefore, emergency department (ED) services, observation

Cheryl Ericson, RN, MS, CCDS, CDIP July 7, 2025

AHA

The Coming Crisis: How Medicaid Provider Tax Restrictions Threaten Hospitals in Red States

Hospitals across the United States face mounting financial strain from Medicaid underpayments, but red states – those with Republican-majority legislatures and governors – stand to

Timothy Powell, CPA, CHCP July 7, 2025

Documentation

Revenue Integrity in a Value-Based World: The Role of HIM Professionals

The shift from fee-for-service to value-based care (VBC) is reshaping how healthcare organizations are reimbursed and evaluated. In this new environment, success hinges not only

Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P July 7, 2025

Documentation

DRG Downgrades by Commercial Payers: Documentation Defense Tactics

In the current climate of cost containment, commercial payers are increasingly downgrading MS-DRGs after claims are submitted, not disputing the need for inpatient care, but

Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P June 30, 2025