Effective July 1, a subtle but significant expansion for the Centers for Medicare & Medicaid Services (CMS) added new requirements to 42 CFR § 482.43
As a quick refresher, last year the U.S. Supreme Court overturned 40 years of precedent and upended statutory construction and enforcement by overturning the Chevron
The healthcare industry’s landscape shifted dramatically with the implementation of the Transparency in Coverage (TiC) Final Rule. For compliance professionals navigating this regulatory terrain, understanding
Over the past few months, a number of my articles have covered a combination of social injustices and oddities from federal agencies. In this article,
Healthcare reimbursement operates on a fascinating paradox: physician services aren’t paid based on market rates or simple invoices, but on calculated values derived from estimated
According to the American Hospital Association (AHA), Medicare reimbursed hospitals at just 82 percent of the cost of care in 2022, meaning hospitals absorbed an
I think it is important to challenge one portion of an article that was widely distributed two weeks ago. The article included a statement that,
Since its creation in 1965, Medicaid has served as a lifeline for low-income individuals, families, and the disabled, offering health coverage in partnership with state
It has been a few weeks since my last legislative update, and while quite a bit has happened during the interim, I’m going to brief
The U.S. Department of Justice (DOJ) announced that Texas rheumatologist Dr. Jorge Zamora-Quezada had been sentenced to 10 years’ imprisonment in connection with the submission
Grab your pens, alert your billing teams, and cue up your electronic medical record (EMR) vendors, because the Centers for Medicare & Medicaid Services (CMS)
Gilead Sciences, Inc. has agreed to pay $202 million to settle allegations raised by whistleblower Dr. Paul Bellman that Gilead violated the False Claims Act
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.
Get two essential perspectives on CMS compliance for $199.
The Two-Midnight Rule helps you navigate short-stay admissions, patient status, and evolving 2026-2027 requirements, while CMS CRUSH explores the next wave of program integrity, payment oversight, and data-driven scrutiny.
Two RACmonitor webcasts. One practical approach to preparing for increased CMS oversight.
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.
Webcast Only Available On ICD10monitor Subscription – Subscribe Below
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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