Hospital coders are geniuses. Not only must they master Current Procedural Terminology ®(CPT) principles when coding outpatient facility and all physician claims, they must adapt
Documentation in utilization review (UR) is practical daily work, but it carries significant operational, financial, and compliance weight. For physician advisors, especially those reviewing patient
Dear Doctor, I know how a query can feel. It arrives mid-shift, wrapped in an abundance of misaligned clinical indicators offering a menu of answers
The chart is complete. Every required field is filled out. The dropdowns are selected, the template is populated, and the note is signed. But can
We are already halfway through September, so time has flown by since we first started thinking about the Inpatient Prospective Payment System (IPPS) Final Rule
EDITOR’S NOTE: This article was prepared with the assistance of ChatGPT. It was then edited by a human being. In one of her final interviews,
EDITOR’S NOTE: The author of this article would like to acknowledge that it was prepared with assistance from ChatGPT. I had vascular surgery recently. The
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) has been around for years, but I am not convinced that clinical documentation integrity (CDI) programs
The final version of the 2026 AHIMA/ACDIS Guidelines for Achieving a Compliant Query Practice Brief has been released. How technology is redefining the query process
Every time a CDI specialist checks whether a pressure ulcer was present on admission before it can trigger a Patient Safety Indicator (PSI) or builds
Ask a group of hospital leaders whether their organization has a Utilization Review (UR) or a Utilization Management (UM) department, and the answers will likely
The central distinction is that postpartum depression is a depressive illness in which reality testing is generally preserved. Postpartum psychosis is marked by impaired reality
A single CDM error can lead to missed revenue, billing issues, denials, and compliance concerns. Learn the fundamentals of effective Charge Description Master (CDM) management and build a stronger foundation for accurate, consistent charge decisions.
Join Michael Calahan, PA, MBA for this radiation oncology coding and compliance webcast as he explains the fundamentals of coding, billing, reporting, and documentation for hospital outpatient and professional services. Learn how the 2026 radiation therapy coding changes affect current practices, how to distinguish technical and professional services, and how to address bundling, units, frequency, modifiers, and documentation requirements. Michael will also help you identify radiation oncology coding and billing vulnerabilities that could lead to denials, overpayments, repayment demands, or federal audit exposure.
The 2027 CMS policy changes will impact case management, utilization review, reimbursement, and patient status decision-making long before they officially take effect. Join nationally recognized physician advisor Dr. Ronald Hirsch as he explains the finalized and proposed inpatient and outpatient rule changes, expanding bundled payment initiatives, payment updates, and evolving payer expectations. Gain practical guidance to help your organization prepare early, strengthen compliance, reduce reimbursement risk, and confidently navigate the transition to 2027.
The Two-Midnight Rule continues to be one of Medicare’s most closely monitored compliance areas and now the rules are changing again. Join compliance expert Michael Calahan for a practical review of the latest 2026 policy updates, the proposed 2027 OPPS changes affecting inpatient-only procedures, and the best practices hospitals need to reduce audit risk, strengthen admission decisions, and protect reimbursement. Leave with actionable strategies you can immediately apply to improve compliance and confidently prepare for increased federal and Medicare Advantage scrutiny.
Avoid costly inpatient coding errors involving ulcers and gangrene. This practical FY 2027 ICD-10-CM webcast clarifies pressure injury staging, non-pressure ulcer severity, diagnosis sequencing, documentation requirements, and POA reporting. Through real-world cases, gain the confidence to make defensible coding decisions, reduce denials, strengthen compliance, and support accurate reimbursement.
What happens when everyone reviews the same chart, but reaches a different conclusion? In this case-based clinical documentation integrity (CDI) webcast, Penny Jefferson examines how documentation involving clinical support, timing, causation, linkage, and terminology can produce very different outcomes for ICD-10 coding, reimbursement, quality, risk adjustment, medical necessity, denials, and compliance. Using cases involving postoperative respiratory failure, severe malnutrition, and encephalopathy, you’ll learn the practical CLEAR framework to help attendees learn to evaluate whether a diagnosis is codeable, consistent, specific, reportable, and ultimately defensible across the different teams and systems that rely on the medical record.
Spinal fusion cases are among the most complex inpatient procedures to code, where even minor ICD-10-PCS errors can affect MS-DRG assignment, reimbursement, compliance, and audit outcomes. This practical webcast provides a step-by-step framework for interpreting operative reports, assigning accurate ICD-10-PCS codes, recognizing documentation gaps, and confidently coding complex fusion procedures. You’ll leave with practical tools that improve coding accuracy, reduce denials and audit risk, and strengthen documentation-driven reimbursement decisions.
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.
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