EDITOR’S NOTE: The author of this article used artificial intelligence (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the
EDITOR’S NOTE: The author of this article used artificial intelligence- (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the
EDITOR’S NOTE: Ongoing discussion about U.S. disengagement from the World Health Organization (WHO), with withdrawal effective Jan. 22, has refocused attention on how global standards
Home Health lives or dies on the quality of its Outcome and Assessment Information Set (OASIS) documentation. OASIS is the standardized assessment tool that every
EDITOR’S NOTE: This piece on RADV audits, written by Frank Cohen, was published on RACmonitor on Aug. 25, 2025. It’s being republished on ICD10monitor because
EDITOR’S NOTE: AI-assisted editing tools were used only for proofreading and language refinement; all analysis, interpretation, and conclusions reflect the author’s original work. Artificial intelligence
Someone recently asked on LinkedIn if they must always sequent a UTI as the principal diagnosis when encephalopathy due to a urinary tract infection (UTI)
I’ve recently encountered a couple of discussions about encephalopathy so I thought others might be interested in this topic. First up, querying for the type
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
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
The State of Audio-Only Telehealth Audio-only telehealth was first broadly permitted under emergency COVID-19 public health flexibilities in 2020. Since then, Congress and the Centers
Last week I wrote about the importance of defining what clinical documentation is, within the scope of clinical documentation integrity (CDI) reviews. This week, I’ll
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.
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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.
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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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.
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