Well, the Centers for Medicare & Medicaid Services (CMS) has released the proposed outpatient rule for 2027, and as expected, they are proceeding with the
Last week I had an interesting conversation with a case management director about everyone’s favorite topic: the Medicare Advantage (MA) plans. Like all businesses, her
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
While many in hospitals find understanding the new regulations on Medicare Advantage (MA) plan denials challenging, it appears that the payers are also having a
As of Jan. 1, the Centers for Medicare & Medicaid Services (CMS) initiated a three-year phase-out of the Inpatient-Only (IPO) List, which fundamentally reshapes how
I am going to start 2026 by doing something I rarely do, and that is compliment an insurance company, and United Healthcare at that. As you
EDITOR’S NOTE: This article was originally published Monday, Dec. 8 by RACmonitor as a special bulletin. Many people are still seething mad about Aetna’s devious
Beginning in 2026, the Centers for Medicare & Medicaid Services (CMS) will begin phasing out the Inpatient-Only (IPO) List by removing predominantly musculoskeletal and complex
Well, by now I am sure all of you have had plenty of time to read the 1,657 pages of the Outpatient Final Rule, so
It finally happened! The Centers for Medicare & Medicaid Services (CMS) finally released the 2026 Outpatient Prospective Payment Final Rule on Friday at 4:15 pm,
It is normally that time of year when many of us not only steal candy from the kids’ Halloween collections (my kids never got to
I’m working on a U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) audit wherein the question invites the reviewer to
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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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