Every provider that bills Medicare has felt the sting of a denied claim. Some denials are one-off mistakes: a transposed digit, a missed modifier. But
Federal officials announced this week that a Fortune 500 healthcare devices and medical supplies company has agreed to pay just shy of $385 million to
It is very easy to get confused about what is and is not protected by the attorney client privilege. If it feels like I have been
There are several proposed reform options in Congress that could make changes to the 340B drug pricing program. There are a few different bills pending
Artificial intelligence companies developing healthcare revenue-cycle tools need large volumes of real claims data. Two of the most valuable sources are the 837 electronic claim
I first have to say that Aetna’s Medicare Advantage (MA) severity adjustment policy is sheer brilliance. We probably shouldn’t be surprised, since this is the
Artificial intelligence (AI) has often been touted as the new frontier in healthcare: a solution to longstanding problems like administrative overload and burnout, helping providers
I am often asked whether I’m an expert on lab billing. I always answer “no,” despite the fact that I have spent considerable time digging
There has been a troubling new development involving Eli Lilly and the 340B drug pricing program. For several months, Lilly has been demanding that hospitals
Policies have the potential to be quite a double-edged sword. Generally speaking, managers love policies, and I think there are several reasons for this. Perhaps the
I am happy to report that there is no major controversy to report on this week. So let me address issues that came up with
Last summer’s Loper Bright decision was supposed to be a watershed moment for administrative law. By overturning Chevron deference, the U.S. Supreme Court declared that
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 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.
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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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