The Centers for Medicare & Medicaid Services (CMS) just released news that they will be working on a 10-year payment and care delivery model called the Transforming Maternal Health Model (TMaH).

I think this report confirms some of the information we have already seen in our hospitals and EDs: that our patients are increasingly more socially and medically complex.

Queries, whether placed by a CDI specialist or an AI solution, need to be compliant and cannot lead providers.

If your facility has not taken steps to ensure that Hierarchical Condition Category (HCC) diagnoses are properly validated, you are just asking to be the next victim in the OIG headlights.

As we step into the new year, the mix of social needs and healthcare will continue to demand our attention.

Today is it is estimated that more than 2 million women of childbearing age live in maternity care deserts, meaning they reside in counties that do not have obstetric care, many of them rural.

Written in March 2013 by the highly respected Dr. Steven Meyerson, “Observing the Rules for Observation after Outpatient Surgery” evolved over time into one of the most-read articles in the history of RACmonitor.

In essence, you are telling the story of the surgery and what happened during recovery in codes. You need the provider to document so you understand the course of events and whether there was a complication or not.

The Biden Administration has released a new playbook addressing three “pillars” of emphasis related to the social determinants of health (SDoH), from the Domestic Policy Council’s Office of Science and Technology Policy.

ABNs are utilized prior to or during the continuation of services that Medicare does not cover when services exceed Medicare frequency coverage guidelines, or when services are deemed not medically necessary.

The Gravity Project and the American Medical Association (AMA) have taken a significant step toward clarifying the coding process for the social determinants of health (SDoH).

A recent study hit the news when the top four AI companies were tested with racial questions regarding healthcare decisions that have been proven false to see if these tools could provide accurate information.

As a case manager, it can be morally distressing to try and place a patient who is medically ready for discharge into a less-than-desirable, post-acute care setting.

It isn’t the operating room location or even the procedure that necessarily determine patient status.

Accurate coding, diligent utilization review, and a clear understanding of the IPO List are vital components of revenue cycle management for healthcare organizations.

While pediatric medicine is advancing year over year, our nation’s hospitals’ capability to provide this level of care is dwindling due to insufficient payment.

The narrative highlights a disappointing story in our healthcare system, wherein we fail to acknowledge and recognize cultural biases and their impact on health equity.

The initial assessment with the patient is the most important and proactive piece for CMs in laying the foundation of the care progression and transition-of-care process.

The capture and accurate billing of these IPO procedures is vital to the hospitals that perform the procedures.

The Centers for Disease Control and Prevention (CDC) released the Hospital Sepsis Program Core Elements: 2023 to monitor and optimize hospital management and improve outcomes of sepsis.