May 20, 2025
ACDIS25 Wrap-Up: From ENspiration to Impact
We’re still feeling the excitement and momentum from ACDIS 2025! It was such a pleasure to connect with so many familiar faces and to meet…
March 25, 2025
March Madness: Defending Against Medicare Advantage Denials for Encephalopathy
March brings excitement of the men’s and women’s Division 1 NCAA tournaments. However, for those dealing with payment denials from Medicare Advantage companies, another concern…
March 5, 2025
Battling the Winds of Denial: Avoiding Payment Reductions for Acute Respiratory Failure
March is windy, and the rapidly changing weather can take your breath away. The ICD-10 codes that catch the most downdrafts are J69.01 and J96.21.
February 10, 2025
Playing Smart Defense Against Medicare Denials
Whether your team won or lost the Super Bowl, we can all appreciate a good sports metaphor. Hospitals and healthcare systems face daily challenges with…
November 28, 2023
Strengthening Clinical Validation to Mitigate Payment Denials: Insights from AHIMA’s Practice Brief
In the realm of healthcare reimbursement, understanding and addressing clinical validity is crucial to minimizing payment denials. This blog delves into the significance…
November 28, 2023
Navigating the Landscape of Query Compliance: AHIMA and ACDIS 2022 Guideline Updates
AHIMA and ACDIS published the updated guidelines for Guidelines for Achieving a Compliant Query Practice—2022 Update this year. How are you…
July 21, 2023
Readmissions: Penalties aren’t so Appealing
Readmission Rates: Readmissions are frequent and costly. It is estimated that there were over 3.8 million 30-day all cause adult…
March 3, 2023
Impact of Proposed HCC Changes
Are you ready for some potentially big changes in the CMS-HCC model? In February, CMS proposed many changes in the model–including for the first time…
December 1, 2022
Pediatric Sepsis: The Denial Dilemma
The Rise of RSV and Influenza The United States is in the midst of a nationwide outbreak of RSV and Influenza A infections. These…
March 29, 2022
Health, Depends on Where you Live
If searching the 2022 IPPS (2,295 pages) for the word determinants, the word appears 18 times. CMS is asking for comments and it appears that…
February 18, 2022
Big Brother is Watching You!
COVID and the OIG As you are aware the CARES Act of 2020 provides for an additional 20% above the billed DRG for treating a…
December 6, 2021
Atrial Fibrillation…A Sticky Subject!
A secondary hypercoagulable state in patients with atrial fibrillation, a sticky subject. Does a secondary hypercoagulable state exist in patients with atrial fibrillation (AF)? This…