Podcasts about icd10

The recent $14.1 million False Claims Act settlement against Complete Health Partners Holdings, a management services organization operating provider groups in Florida, Alabama, and Colorado, brings to light the role coders can play in False Claims Act cases.In this instance, it was alleged that Complete Health Partners Holdings directed physicians to add high-value, risk-adjusting codes for Drug and Alcohol Dependence and Major Depressive, Bipolar, and Paranoid Disorders to the medical records of Medicare Advantage patients when those codes were not indicated.So, listen and learn when special guest Liz Soltan, counsel for Whistleblower Partners, will discuss the role of coders in these cases.The popular weekly Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:• POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.• CDI Report: Cheryl Ericson will provide an update on all things clinical documentation integrity (CDI).• SDoH Report: Tiffany Ferguson will report on news happening at the intersection of compliance and medical record coding.• The Coding Report: Christine Geiger will report on the latest coding news.• Talk Ten Tuesday News Desk: Timothy Powell, will deliver the latest news from the Talk Ten Tuesday News Desk.

You wear a smartwatch as do so many other Americans. In fact, AI is transforming wearable healthcare devices from simple fitness trackers into powerful tools that collect, analyze, and share health information in real time.During the next live edition of the long-running Monitor Monday Internet broadcast, special guest Ray Ribble will take a deep dive into AI-powered wearables and explain what you and your team must do to remain compliant.The broadcast will also include these instantly recognizable segments:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Utilization managers (UMs) have long served as a resource for clinicians determining the appropriate patient status.Key considerations include which clinicians are involved, how communication occurs, and how status orders are entered.Because these processes can vary widely, it is essential to understand what is compliant, what carries risk, and what is simply not allowed.That's why it's essential to stay current on the latest developments in utilization management.So, listen and learn when special guest Dr. Juliet B. Urgarte Hopkins, chief medical officer for Phoenix Medical Management discusses the role of utilization managers.The popular weekly Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:• POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.• CDI Report: Cheryl Ericson will provide an update on all things clinical documentation integrity (CDI).• SDoH Report: Tiffany Ferguson will report on news happening at the intersection of compliance and medical record coding.• The Coding Report: Christine Geiger will report on the latest coding news.

The Department of Justice (DOJ) recently announced “data sharing” agreements with the Centers for Medicare & Medicaid Services (CMS), the Department of Homeland Security (DHS) and the Federal Trade Commission (FTC). Many believe this latest development might be the most consequential enforcement shift in twenty years. DOJ can now run analytics directly against CMS claims data, DHS travel records, and FTC complaint data, all in one shared environment.During the next live edition of the venerable Monitor Monday Internet broadcast, senior healthcare analyst Frank Cohen, program's special guest, says it's the data sharing agreement has changed everything. Register now to listen and learn when Cohen explains why the idea of a defensible pattern just got a lot bigger. It's important that you need to know what this means for your data.The broadcast will also include these instantly recognizable segments:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, legislative affairs liaison for Zelis, will report on current healthcare legislation.

Tuesday, July 28 marks the 700th live edition of the commemorative Talk Ten Tuesdays broadcast. And in honor of this celebration, the ICD10monitor producers of the popular news and information service have invited Dennis Jones, the assistant vice president of revenue cycle for Jefferson Health, to be the guest host.During the first half of the broadcast, our other well-known subject-matter experts will also join the broadcast with more news to report, including the following:• Tech Report: Senior healthcare analyst Frank Cohen to reveal how when claims are viewed in isolation, there is a great likelihood of audits.• POV: Penny Jefferson, cohost of Talk Ten Tuesdays, will share her point of view (POV) during the broadcast.• The Coding Report: Chris Geiger, will report on the latest coding news.• CDI Report: Cheryl Ericson will provide an update on clinical documentation integrity (CDI).• SDoH Report: Tiffany Ferguson, the CEO for Phoenix Medical Management, will report on news that's happening at the intersection of patient care and medical record coding.Then, during the second half of the broadcast, we have invited a host of renowned guest panelists, including the following:1. Edward Roche2. Ronald Hirsch, MD3. Matthew Albright4. Maureen Testoni. Esq.5. Denise Buenning6. Fred Stodolak

Maybe it's the summer doldrums that keep otherwise rational people from taking a chance—especially when better alternatives may be available. But according to physician and attorney Dr. John K. Hall, the special guest on the next live edition of Monitor Mondays, some individuals prefer to maintain the status quo rather than pursue a potentially better approach. Case in point: Aetna's recent discharge policy. Beyond the policy itself, which seems to be causing consternation among some hospitals, are there other examples? Listen to the special broadcast Monday, July 27, at 10:00 a.m. EST.The broadcast will also include these instantly recognizable segments:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, legislative affairs liaison for Zelis, will report on current healthcare legislation.

The squeeze is on.Federal enforcement is intensifying, with behavioral health agencies facing heightened scrutiny following revealing reports from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). According to the OIG, there have been numerous fraud cases involving false claims and falsified documentation.But among this emerging sturm und drang, there is a critical role that health information management (HIM) can play – as you and your team will learn during the next live edition of Talk Ten Tuesdays. That's when special guest Veronica Richardson, senior compliance consultant at First Class Solutions, will discuss how HIM can play a significant role in behavioral health compliance.The popular weekly Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:• POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.• CDI Report: Cheryl Ericson will provide an update on all things clinical documentation integrity (CDI).• SDoH Report: Tiffany Ferguson will report on news happening at the intersection of compliance and medical record coding.• The Coding Report: Christine Geiger will report on the latest coding news.

Who would have thought that the otherwise fairly simple Medicare Cost Report could be a serious compliance trap?Some are calling the new Medicare report worksheet a possible precursor to the most significant reimbursement change in decades.For 2026, the Centers for Medicare & Medicaid Services (CMS) will require hospitals to report Medicare Advantage (MA)-negotiated reimbursement by Medicare Severity Diagnosis-Related Group (MS-DRG).The implications extend far beyond compliance, requiring coordination across reimbursement, finance, revenue cycle, managed care, coding, IT, and analytics.Listen and learn during the next edition of Monitor Mondays when the CEO for Panacea Healthcare, Kevin Chmura, unpacks Worksheet S-12. You'll quickly discover the finer details of the looming fundamental shift toward market-based reimbursement, and how forward-thinking hospitals can turn this change into a strategic advantage.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, BA, CPMA, CPC, CMC, ICD-10-CM.Thanks to all of you for making this a Top 15 Medical Billing & Coding Podcast for 5 Years on Feedspot. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Sonal's 18th Season starts up and Episode 7 features a Newsworthy update on ICD10 codes for FY 2027.Sonal's Trusty Tip highlights compliance recommendations for hospital beds and accessories.Spark inspires us all to reflect on change based on the inspirational words of Jim Rohn.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Paint The Medical Picture Podcast now on:Spotify: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Apple Podcasts: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id153044217⁠7⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Amazon Music: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://music.amazon.com/podcasts/bc6146d7-3d30-4b73-ae7f-d77d6046fe6a/paint-the-medical-picture-podcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Find Paint The Medical Picture Podcast on YouTube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Find Sonal on LinkedIn:⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/sonapate/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠And checkout the website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://paintthemedicalpicturepodcast.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠PaintTheMedicalPicturePodcast@gmail.com⁠⁠⁠⁠

The secondary review: Corrective Backup? Or a layer of quality assurance?Given that clinical documentation integrity (CDI) invariably has interpretative variability, a secondary review is intended to bring consistency to complex issues, according to the Talk Ten Tuesday special guest, Mary McGrady, vice president of CDI for Accuity Health. During the next live edition of the popular Internet broadcast, Mary McGrady will clear up the misunderstanding of the secondary review.Other well-known subject-matter experts will also join the broadcast with more news to report, including the following:• SDoH Report: Tiffany Ferguson will report on news happening at the intersection of compliance and medical record coding.• The Coding Report: Christine Geiger returns to Talk Ten Tuesdays to report on the latest coding news.• POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.

Payer-driven clinical validation is a common reason given by payers to remove ICD-10-CM/PCS diagnosis and procedure codes affecting reimbursement or quality-based payment models (e.g., the Centers for Medicare & Medicaid Services/CMS Hospital-Acquired Conditions), even though these codes are based on the documentation of licensed providers.During the next Internet broadcast of the venerable Monitor Monday, Dr. James S. Kennedy of CDIMD will propose a strategy that engages payers in how patient conditions or treatments should be defined, diagnosed, and documented, elevating the practice of medicine and confronting denials that are often based on misinterpretations of current clinical literature.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, legislative affairs liaison for Zelis, will report on current healthcare legislation.

What happens when the Inpatient-Only (IPO) List goes away?The entire list is expected to be eliminated Jan. 1, 2028.This will necessitate careful, patient-specific status determinations, rather than automatic assumptions based only on the procedure being performed.The removal of a procedure from the IPO list does not mean that every such procedure must be classified as “outpatient.” Instead, the clinical team must evaluate the individual patient's medical condition, functional needs, home situation, and anticipated post-operative course.Listen and learn during the next upcoming edition of Talk Ten Tuesdays, when Dr. Juliet Ugarte Hopkins will offer practical patient function concepts for supporting inpatient status in the absence of the IPO list.Other well-known subject-matter experts will also join the broadcast with more news to report, including the following:• CDI Report: Cheryl Ericson will provide an update on all things clinical documentation integrity (CDI).• SDoH Report: Tiffany Ferguson will report on news happening at the intersection of compliance and medical record coding.• The Coding Report: Christine Geiger returns to Talk Ten Tuesdays to report on the latest coding news.• POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.

Behavioral health services continue to face heightened payer scrutiny. The result: inaccurate documentation, coding, and compliance issues.Panacea Healthcare recently hosted a webinar that focused on three high-risk areas: relative to Behavioral Health–telehealth, psychotherapy with evaluation and management (E&M) services, and the Collaborative Care Model (CoCM).Special guest George Kelly is expected to summarize these issues while outlining the common compliance pitfalls, documentation requirements, coding best practices, and audit risks associated with each service.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, legislative affairs analyst for Zelis, will report on current healthcare legislation.

Public comments have closed on the 2026 AHIMA-ACDIS Query Practice Brief.In other words, the time to talk is over, and the time to listen has begun.During the next live edition of the popular Internet broadcast Talk Ten Tuesdays, produced by ICD10monitor, you can hear out senior healthcare attorney Richelle Marting as she leads a reflection session to review key themes from the Brief.She will also share her analysis of those themes, including the concept of a “compliant” and “non-compliant” query and the problem with referring to certain query formats as “leading.”If you have had claims denied by third-party payers for “non-compliant” queries or if you have wondered how your organization would respond to allegations of leading or non-compliant queries, you'll want to listen to this remarkable broadcast.What's changed? And what does it really mean to issue a “compliant” query in today's healthcare landscape?Listen and learn.Other well-known subject-matter experts will also join the broadcast with more news to report, including the following:• POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.• CDI Report: Cheryl Ericson will provide an update on all things clinical documentation integrity (CDI).• SDoH Report: Tiffany Ferguson will report on news happening at the intersection of compliance and medical record coding.• The Coding Report: Christine Geiger returns to Talk Ten Tuesdays to report on the latest coding news.

There's a method by which providers can avoid the snare of the latest claim denial strategy to garner attention. Much has been written about the Aetna policy for its “severity inpatient payment” element.Yet almost daily, providers appear to be turning to trusted sources to avoid pitfalls. And that is why the producers of RACmonitor's Monitor Mondays have invited physician and attorney Dr. John K. Hall to serve as special guest during the next edition of the venerable weekly national podcast.During this remarkable live Internet broadcast, Dr. Hall will unpack the issues that seem to flummox payers, resulting in a variety of actions, ranging from recoupment to reimbursement at lower levels (i.e. “observation” rates).Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, legislative affairs analyst for Zelis, will report on current healthcare legislation.

After a two-year hiatus, the PEPPER (Program for Evaluating Payment Patterns Electronic Report) is back. It's now available to all acute care hospitals and critical access hospitals. During the next live edition of Talk Ten Tuesday, Dr. Ronald Hirsch will share some insights that listeners can get from their PEPPER to improve their hospital's compliance, quality, and revenue.  To learn more, register now to secure your seat at the table during the next live edition of Talk Ten Tuesdays, coming up at 10 a.m. EST on Tuesday, June 23.Other well-known subject-matter experts will also join the broadcast with more news to report, including the following: •Tech Report: Senior healthcare analyst Frank Cohen concludes the third installment in his three-part series on AI and coding.•POV: Penny Jefferson, cohost of Talk Ten Tuesdays, will share her point of view (POV) during the broadcast.•The Coding Report: Rose Dunn, who will substitute for Christine Geiger, will report on the latest coding news.•CDI Report: Cheryl Ericson will provide an update on clinical documentation integrity (CDI).•SDoH Report: Tiffany Ferguson, the CEO for Phoenix Medical Management, will report on news that's happening at the intersection of patient care and medical record coding

Motivated by the notion that healthcare providers are seeking compliance solutions across the revenue cycle, the producers of Monitor Mondays have invited the CEO of Panacea Healthcare Solutions to serve as the special guest during the next upcoming broadcast.Introducing Kevin Chmura. For more than 25 years, Mr. Chmura has been at the forefront of major healthcare vendors as they, in turn, have worked to help their clients achieve success in revenue cycle compliance.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, legislative affairs analyst for Zelis, will report on current healthcare legislation.

Nearly every American hospital has at least one physician advisor.So, how does the physician advisor at your facility measure up? We reached out to longtime physician advisor Dr. Juliet Ugarte Hopkins to address this issue in her capacity as the special guest for the upcoming live edition of the popular Talk Ten Tuesday broadcast.According to Dr. Ugarte Hopkins, also the chief medical officer for Phoenix Medical Management, “physician advisors should be involved in far more (activities) than secondary status reviews and peer-to-peer calls.”To learn more, register now to secure your seat at the table during the next live edition of Talk Ten Tuesday, coming up at 10 a.m. EST on Tuesday, June 16.Other well-known subject-matter experts will also join the broadcast with more news to report, including the following:• Part II: Coding and AI Senior healthcare analyst Frank Cohen, continues with Part 2 in his three-part series on coding and artificial intelligence.• POV: Penny Jefferson, cohost of Talk Ten Tuesdays, will share her point of view (POV) during the broadcast.• The Coding Report: Deanna Peterson, who will substitute for Christine Geiger, will report on the latest coding news.

Maureen Testoni, the stalwart president and CEO of the renowned 340B Health Program, will join the long-running Monitor Mondays todiscuss Eli Lilly's escalating demands for hospitals to submit in-house claims data as a condition of receiving 340B drug discounts. Who will blink first?Register now to reserve your participation.Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.·      Legislative Update: Folana Houston, legislative affairs analyst for Zelis, will report on current healthcare legislation.

There's a quiet battle taking place, with no field hospitals for the sick and wounded, and no bloodshed.But the stakes are high, and the losses are unforgiving.It's the battle of algorithms.Employed by both payers and providers, the ultimate prize: money, in the form of reimbursement from submitted claims for medical care. Payers deny and recoup. Providers bill as margins shrink.During the next live edition of the ever-popular Talk Ten Tuesdays broadcast, senior healthcare analyst Frank Cohen, himself a veteran of algorithmic warfare, will escort you behind the front lines and into war rooms, so that you will have a better understanding of what is contributing to rising medical costs. Cohen's three-part article series on ICD10monitor.com begins this coming Tuesday.Other well-known subject-matter experts will also join the broadcast with more news to report, including the following:• POV: Penny Jefferson, cohost of Talk Ten Tuesday, will share her point of view (POV) during the broadcast.• CDI Report: Cheryl Ericson will provide an update on all things clinical documentation integrity (CDI).• The Coding Report: Christine Geiger will report on the latest coding news.

At the heart of a recent lawsuit filed by a physician is whether the medical profession's understanding and practice of racial concordance is legally defensible.“Find-A-Black-Doctor” has served as a platform for Black, Indigenous, and Persons of Color (BIPOC) to locate providers who can offer them the best holistic treatment.However, some see this as discrimination against white-majority physicians, curtailing their access to potential patients.During my next live edition of Monitor Monday, Dr. Drew Updike, ] review the evidence behind concordance – as it pertains to women's health, BIPOC patients, and others – to provide you your team with an appreciation of its relevance in modern medicine.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.

Although one could conclude that artificial intelligence (AI) is a relatively new technology in healthcare, the reality is that AI has been silently working in the shadows for a while now.During the next live edition of the popular Talk Ten Tuesdays broadcast, you'll hear how AI is guiding the technology of the automated query technology at HITEKS, under the supervision of Gerasimos Petratos, founder and CEO.And what about the thousands and thousands of healthcare coders? Although AI is changing how healthcare claims are managed, as the technology takes on more straightforward coding tasks, coding professionals are shifting into higher-level validation, analysis, and oversight, according to Raemarie Jimenez, the president of membership for AAPC.Join us as we explore how AI is reshaping coding workflows and what coders should be preparing for now.Other well-known subject-matter experts will also join the broadcast with more news to report, including the following: POV: The legendary Rose Dunn, past president of the American Health Information Management Association (AHIMA), will serve as the guest cohost, sharing her point of view during the broadcast.CDI Report: Cheryl Ericson will provide an update on all things clinical documentation integrity (CDI).The Coding Report: Christine Geiger will report on the latest coding news.

It's that bright new shiny object few seem to manage to resist: artificial intelligence (AI).Here at RACmonitor and Monitor Mondays, we have been reporting on how this disruptive technology has been altering the compliance landscape.And we will continue that reporting. AI is rapidly reshaping healthcare auditing and compliance, and as organizations move toward greater claim visibility and AI-driven review processes, what does that mean for audit exposure, risk, and oversight? Join us during the next live edition of the venerable Monitor Mondays broadcast for an incredible journey, as Pam Warren explores how AI is changing the compliance landscape, and what organizations should be thinking about now. Warren, from AAPC, is the manager of regulatory billing audits for MaineHealth in Maine, the largest healthcare system in Northern New England.Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.·      Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

At last, the secrets of healthcare technology will be revealed during a fresh new two-part series, especially written for the accomplished healthcare professional who wants a refresher course on the latest developments that are quickly enveloping healthcare.Coders, clinical documentation integrity specialists (CDISs), and Revenue Cycle professionals who comprise the Talk Ten Tuesday (TTT) audience and who live inside the chart and the queue, are expected to benefit from an eye level rather than at the strategy level approach from senior healthcare analyst Frank Cohen, a renowned computer scientist and respected Monitor Monday panelist.Other well-known subject-matter experts will also join the broadcast with more news to report, including the following:• IPPS Proposed Rule: George Kelly, President of KA Consulting Division at Panacea Healthcare Solutions, will provide an overview of the 2027 IPPSS Proposed Rule during a presentation on May 28.• POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.• CDI Report: Cheryl Ericson will provide an update on all things CDI.• SDoH Report: Tiffany Ferguson will report on news happening at the intersection of compliance and medical record coding.• The Coding Report: Christine Geiger will report on the latest coding news.

Introducing FOCUS (Fraud Oversight through Careful Use of Statistics).  The U.S. Department of Justice (DOJ) has launched a new initiative in response to the surge in False Claims Act qui tam filings by data miners.Today, roughly 45 percent of DOJ cases involve FCA data miners. You and your team will learn the inside story of this new initiative along with news of two significant data miner-initiated cases: a $6.73 million settlement against a California vascular physician who billed Medicare for unnecessary stent procedures at 30 times the national average; and a $300,000 settlement against three Illinois skilled nursing facilities that billed Medicare for unnecessary and inflated rehabilitation services.Reporting this dramatic story will be whistleblower attorney and a partner in the New York office of Whistleblower Partners, Hamsa Mahendranathan. Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.·      Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

The role of physician advisor began as a friendly clinical champion for case/utilization management and clinical documentation integrity (CDI) teams. Today, the role has evolved into a catchall profession within hospitals.  With a scope that encompasses multiple departments within revenue cycle, quality, and hospital utilization, it has becoming increasingly difficult for single individuals to successfully engage with and meet the needs of these groups.   Enter the concept of sub-specialization within physician advisory teams. How can the labor be strategically divided and effectively managed? Learn more from Juliet Ugarte Hopkins, MD, Chief Medical Officer of Phoenix Medical Management, Inc., during the next live episode of Talk Ten Tuesday.Other well-known subject-matter experts will also join the broadcast with more news to report, including the following:·      POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.·      CDI Report: Cheryl Ericson will provide an update on all things CDI.·      SDoH Report: Tiffany Ferguson will report on news happening at the intersection of compliance and medical record coding.·      The Coding Report: Christine Geiger will report on the latest coding news.

Healthcare compliance has entered the machine-learning era, and most organizations have not yet noticed. Providers are using artificial intelligence (AI) to generate documentation, surface reimbursable conditions, and tighten coding workflows. Regulators and payers are using AI to detect abnormal patterns, flag statistical outliers, and identify documentation that does not align with expected clinical behavior. Both sides are operating faster than traditional human oversight can follow, according to senior healthcare analyst Frank Cohen, the special guest during the next live edition of the long-running Internet broadcast Monitor Monday, coming your way Monday, May 11 at 10 a.m. EST.Join Cohen as he walks you and your team through a labyrinth of AI obstacles so you can avoid fines, takebacks, and penalties.Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.·      Legislative Update: Folana Houston, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

What's new for the proposed 2026 American Health Information Management Association/Association of Clinical Documentation Integrity Specialists (AHIMA-ACDIS) Practice Brief?What's unchanged? And what does it really mean to issue a “compliant” query in today's healthcare landscape?According to healthcare attorney Richelle Martin, the special guest for the next live edition of the popular Internet broadcast Talk Ten Tuesday, there's plenty to talk about.The 2026 draft practice brief hits all the hot-button issues, like artificial intelligence (AI)-generated queries, repeat questioning, and the use of prior encounters, while reinforcing the core principle that queries function first and foremost to facilitate a complete and accurate medical record.Perhaps most provocatively, according to Martin, the document pushes back on misuse of query guidance by auditors and payers, clarifying that these guidelines aren't meant to serve as weapons for denials.Other well-known subject-matter experts will also join the broadcast with more news to report, including the following:• POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.• CDI Report: Cheryl Ericson will provide an update on all things CDI.• SDoH Report: Tiffany Ferguson will report on news happening at the intersection of compliance and medical record coding.• The Coding Report: Dr. Franklin Martin, who will substitute for Christine Geiger, will report on the latest news regarding the CMS Two-Midnight rule.• News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

Documenting and coding sepsis has challenged virtually everyone in healthcare ever since Sepsis-3 redefined the condition in 2016 as a “life-threatening organ dysfunction due to a dysregulated host response to infection.”Meanwhile, ICD-10-CM still maintains the older Sepsis-2 language of sepsis (SIRS/Systemic Inflammatory Response Syndrome due to infection, without organ dysfunction) and severe sepsis (sepsis that does result in organ dysfunction).During the next live edition of Monitor Monday, Dr. James S. Kennedy will report on efforts currently underway to address the recent Centers for Disease Control and Protection (CDC) proposal to align ICD-10-CM to Sepsis-3/Phoenix terminology, and to introduce new codes for “impending sepsis,” also known as pre-sepsis: a morbid continuum between a localized infection with and without Sepsis-3/Phoenix-defined sepsis .Dr. Kennedy is expected to solicit assistance from Monitor Mondays listeners toward a reasonable solution.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

Learning how daily payer logs can help you and your utilization review (UR) team identify denials earlier, strengthen communication between UR and clinical documentation integrity (CDI), and improve the defensibility of medical necessity carries the potential to be a game-changer for healthcare professionals.During the next episode of Talk Ten Tuesday, Teri Rice, a regulatory specialist with HCPro, will highlight actionable strategies to reduce your facility's risk and improve outcomes.The popular weekly Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:• POV: Penny Jefferson will share her point of view during the broadcast.• CDI Report: Cheryl Ericson will provide an update on all things CDI.• SDoH Report: Tiffany Ferguson, will report on news happening at the intersection of compliance and medical record coding.• The Coding Report: Christine Geiger will report on the latest coding news.• News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

The recent U.S. Supreme Court decision in Chiles v. Salazar doesn't really close the case – but it also doesn't really leave it open. The 8-1 decision, in which the nation's highest court ruled that a Colorado ban on so-called “conversion therapy” for juveniles was unconstitutional, is subtle, complex, and unnerving; the American Psychological Association issued a statement noting that it was “deeply concerned” over it. The case relates to conversion therapy as talk therapy, specifically related to gender identity and First Amendment rights. But the decision only remands the matter for further review by the Tenth Circuit, thus leaving the issue essentially undecided. Is this just more judicial “Calvinball” – the game highlighted in the classic comic strip Calvin and Hobbes, in which the rules are made up on the fly – or is the Court simply assuring another bite at this apple? Our own Physician and attorney Dr. John K. Hall will explore these questions and look for answers during the next edition of Monitor Mondays.Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.·      Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Monday, April 20, 2026 - Week 17   CURE SYNGAP1 joins the Haystack Project in petitioning FDA for more clarity. PR: https://static1.squarespace.com/static/5966cc2220099e91326caaec/t/69d7dbb80155f46e144ae2e5/1775754168227/4.9.26+press+release+petition_vf.pdf Petition: https://static1.squarespace.com/static/5966cc2220099e91326caaec/t/69d7e016d5986e16ff09b64c/1775755288463/Letter+Head+Petition+for+rulemaking+to+amend%C2%A021+CFR+%C2%A7+314.126+and+%C2%A0%C2%A7312.47+%281%29.pdf Reuters 4/1: https://www.reuters.com/sustainability/boards-policy-regulation/rare-disease-advocacy-group-urges-trump-administration-restore-fda-clarity-2026-04-01/ Pink Sheet: https://insights.citeline.com/pink-sheet/pathways-and-standards/review-pathways/could-structured-not-ad-hoc-us-fda-flexibility-increase-rare-disease-development-certainty-BYXJENIJLFEINOSO72RS53ZJHE/   Show your support here: https://www.regulations.gov/document/FDA-2026-P-3666-0001 Paragraph 1 – Share information about you and SYNGAP1. Paragraph 2 – Seizures are hard to count while X, Y and Z are major burdens but FDA wants nice countable seizures, this makes it hard to develop drugs. Paragraph 3 – How could “clinically meaningful” endpoints potentially help your community and drug developers? How could a study design other than a ‘randomized clinical trial' help? How could FDA consulting with disease-specific experts help? Closing  – Finish your letter with anything along these lines: We support the framework for all rare set diseases in Haystack's petition. We don't believe FDA has to lower the evidentiary bar to approve treatments for our diseases. Randomization isn't always possible. New scientific methods should be considered. Endpoints specific to our disease should be considered. We urge FDA to open a rulemaking so we can have a legally binding regulation.   Board changes, thank you to everyone. https://www.linkedin.com/posts/curesyngap1_curesyngap1-syngap1-patientadvocacy-activity-7450528611339616256-4MJF?utm_source=share&utm_medium=member_desktop&rcm=ACoAAAAD8f4B7JC4TMss45Q8hrsq5kiceI0Z8HE Press Release cureSYNGAP1.org/PR45   US, use your ICD-10, F78.A1: https://onlinelibrary.wiley.com/doi/10.1002/epi.70142   Study list! Citizen Health https://www.citizen.health/ai-advocate/syngap1 Combined Brain (May 1 & 2 in NorCal), https://docs.google.com/presentation/d/1IjaHILXj7AlBDlbTJgvYrkBS_0bnI8VCnTIiPXJ7JGM/edit?usp=sharing  ProMMiS https://www.linkedin.com/feed/update/urn:li:activity:7450196488300728320  Rare-X, the same week. DSC and Cook's are coming soon! CURE-ID for Drug responses.   CURE-ID is cool. https://cure.ncats.io/home (Webinar coming) Webinar: Thu May 7, 2026 1:30pm – 3pm (PDT) cureSYNGAP1.org/cureID    6th ANNUAL SPRINT FOR SYNGAP1, EVERYWHERE – 5 days - $207k! Go Tavilla. 17 teams raised $265K last year; this year, we have 20+ teams! https://curesyngap1.org/calendar/sprint4syngap-2026 Thank your Rifton for the donation of the tricycle. Email today: https://mailchi.mp/curesyngap1.org/sprint-for-syngap-2026-one-community-one-goal?e=17610baa03   INAUGURAL SF NIGHT OF IMPACT, CA – 38 days Join us this is our only Gala for 2026! cureSYNGAP1.org/SF26   5TH SCRAMBLE FOR SYNGAP, SC – 166 days  Classic case of a small event becoming an institution! cureSYNGAP1.org/Scramble26 PUBMED Pubmed 2026 is at 26. +9 vs the week. (61 last year was +9) https://pubmed.ncbi.nlm.nih.gov/?term=syngap1&filter=years.2026-2026&sort=date   SOCIAL MATTERS 4,891 LinkedIn.  https://www.linkedin.com/company/curesyngap1 1.55k YouTube.  https://www.youtube.com/@CureSYNGAP1 11.1k Twitter https://twitter.com/cureSYNGAP1 45k Insta https://www.instagram.com/curesyngap1   $CAMP closed at $4.67 Friday. https://www.google.com/finance/beta/quote/CAMP:NASDAQ   Like and subscribe to this podcast wherever you listen.  https://curesyngap1.org/podcasts/syngap10 Episode 205 of #Syngap10 #CureSYNGAP1 #Podcast

The Association of Clinical Documentation Integrity Specialists (ACDIS) will conclude the formal agenda of its Annual Conference at the close of business next Tuesday in Chicago, but not before the preeminent Dr. James S. Kennedy reports on the highlights of the 2027 Inpatient Prospective Payment System (IPPS) Proposed Rule.Kennedy, no stranger to the Talk Ten Tuesday audience, will be the special guest during the next live edition of the popular Internet radio broadcast produced by ICD10monitor.According to Chuck Buck, the program's executive producer and program host, Dr. Kennedy brings a unique perspective to the subject because he has “an innate sense of coders and the challenges they face to assign correct codes.”The weekly broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:·      SDOH Report: Tiffany Ferguson will report on news that's occurring at the intersection of medical record coding and healthcare compliance.·      CDI Report: Cheryl Ericson will provide an update on all things clinical documentation integrity (CDI).·      The Coding Report: Christine Geiger will report on the latest coding news.·      News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.·      Point of View: Talk Ten Tuesdays cohost Penny Jefferson will report on a healthcare issue that has caught her attention.

Artificial intelligence (AI) is clearly here to stay – it's now an integral part of healthcare. From coding and clinical validation to payer denials and appeals, AI is often a form of power upon which decisions are made by providers, payers, and auditors.You and your team should be aware of the several so-called healthcare “sherpas” available to interpret vast amounts of AI-generated data, among them Grok 4: an AI-powered chatbot solution developed by Elon Musk's xAi, which is integrated with the X (formerly Twitter) social network.As we have before, our producers invited RACmonitor Investigative Reporter Edward M. Roche to investigate AI and its sherpas, including Grok 4, during the next edition of the long-running Monitor Mondays Internet broadcast, this coming Monday, April 20, at 10 a.m. EST.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Many of you dedicated healthcare professionals no doubt often find yourselves wearing many different hats, as does Penny Jefferson, cohost of the long-running Talk Ten Tuesdays weekly national podcast.During the next live edition of the popular Internet program, Jefferson will serve as our special guest.Jefferson is expected to report on the recent guidance and enforcement from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). The nation's healthcare watchdog has placed renewed focus on risk-adjustment accuracy, defensible documentation, and compliance across both Medicare Advantage (MA) and value-based payment models.The popular weekly Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:• SDOH Report: Tiffany Ferguson will report on news that's occurring at the intersection of medical record coding and healthcare compliance.• CDI Report: Cheryl Ericson will provide an update on all things clinical documentation integrity (CDI).• The Coding Report: Christine Geiger will report on the latest coding news.• News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

When the U.S. Supreme Court overturned Chevron deference, it promised to restore judicial independence and limit agency overreach. But in Medicare administrative proceedings, that promise remains unfulfilled. Tune in to the next upcoming live edition of Monitor Mondays, when senior healthcare analyst Frank Cohen will report on his surprise when an Administrative Law Judge issued a categorical ruling: Loper Bright simply does not apply to the proceedings of the Office of Medicare Hearings and Appeals (OMHA).Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Dr. Jennifer Weinberg will be making her Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.·      Legislative Update: Adam Brenman will report on current healthcare legislation.

As federal oversight of risk adjustment and documentation practices intensifies, healthcare organizations are facing new scrutiny regarding how patient complexity is documented and reported. Recent guidance and enforcement activity from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has placed renewed focus on risk-adjustment accuracy, defensible documentation, and compliance across both Medicare Advantage (MA) and value-based payment models. During the next episode of Talk Ten Tuesday, Jason Jobes, a CDI expert, will discuss why outpatient clinical documentation integrity (CDI) programs are becoming increasingly important in this environment. He will explore how documentation practices, provider education, and governance strategies can help organizations accurately capture patient complexity while reducing audit exposure and protecting revenue.The popular weekly Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:·      POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.·      CDI Report: Cheryl Ericson will provide an update on all things CDI.·      The Coding Report: Christine Geiger will report on the latest coding news.·      News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

National Doctor's Day will bring a double whammy this coming Monday when the venerable Monitor Monday continues its recognition of the occasion with a pair of featured speakers: Drs. Drew Updike and Christopher Boyle.The day of recognition took place on March 30, the date when Eudora Brown would place flowers on the graves of late physicians, starting in 1933. Historians are quick to note that the date also commemorates the first use of anesthesia for surgery.Fast forward to Monday, April 6, 2026: that's when Drs. Updike and Boyle will not only be recognized for their service by Monitor Mondays, but featured as speakers.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

A recent False Claims Act case is raising an important question for CDI professionals: what if the diagnosis is clinically valid, but the process behind it is challenged? During the next live edition of the popular Talk Ten Tuesdays podcast, Dr. Robert Oubre, director of CDI and UM at St. Tammany Health System, will report on a motion for summary judgement on a case (Smith vs Mercy Health) on how malnutrition documentation and electronic medical record (EMR) workflows came under scrutiny. Dr. Oubre will also discuss the role of AHIMA guidance and the importance of compliance oversight. This is a must listen for CDI, coding, and compliance leaders.The popular Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:·      POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of Davis Medical Center, will share her point of view during the broadcast.·      CDI Report: Cheryl Ericson will provide an update on clinical documentation integrity (CDI).·      The Coding Report: Christine Geiger will report on the latest coding news.·      News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

Artificial intelligence (AI) is becoming part of how clinical documentation is reviewed across healthcare, from coding and clinical validation to payer denials and appeals. In many cases, AI is influencing decisions behind the scenes, even when it is not clearly visible.During the next live edition of the long-running Monitor Monday, the Internet broadcast produced by RACmonitor, Sharon Easterling will explain in simple terms how AI reads the clinical record. Unlike clinicians, AI does not understand the full story of the patient. Instead, it looks for patterns such as words, phrases, and signals, and uses those patterns to reach a conclusion.Because of this, the same record can lead to different outcomes. Easterling, RACmonitor and Monitor Monday technology consultant, returns to the broadcast and will use a straightforward way to evaluate decisions so that conclusions remain supported, clear, and defensible, even as AI becomes more involved in the process.Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney Amanda Mills will join the broadcast with his trademark segment.·      Legislative Update: Matthew Albright, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Data breaches have unfortunately become a fact of life in America's healthcare system.The next edition of the popular Talk Ten Tuesdays will focus on just the latest in a succession of such incidents, as providers scramble to determine what to do to prevent cyberattacks – and how to react when they arise, nonetheless.The popular Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:• POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of Davis Medical Center, will share her point of view during the broadcast.• CDI Report: Cheryl Ericson will provide an update on clinical documentation integrity (CDI).• The Coding Report: Christine Geiger will report on the latest coding news.• News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

Aetna is just the latest in a long list of healthcare entities to settle False Claims Act (FCA) allegations with a massive settlement.The insurer, one of the nation's largest, recently agreed to pay $117.7 million to resolve a case involving purportedly inaccurate and untruthful diagnosis codes to increase payments. That and other recent U.S. Department of Justice (DOJ) actions will take center stage during the next edition of Monitor Mondays, when featured speakers will weigh in on striking recent trends related to such developments. Settlements and judgments under the FCA totaled $6.8 billion in the most recent full fiscal yar, an all-time record, with 84 percent of the recoveries related to matters involving the healthcare industry. Broadcast segments will also include these instantly recognizable features:•Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. •The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. •Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.•Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

After two powerful segments introducing her neurodiversity coding initiative, Tami McMasters Gomez, Executive Director for the Mid-Revenue Cycle, Enterprise-Wide Coding and CDI Operations for the University of California Davis Medical Center, returns to report on how this program is unlocking untapped strengths, improving accuracy, and building a more resilient health information (HIM) workforce. Plus, you and your team will learn first-hand the impact that neurodiverse professionals are already making in the coding workforce.Most importantly, you'll come to understand why programs like this one may represent an important pathway to both expanding opportunity and strengthening the future healthcare workforce.Broadcast segments will also include these instantly recognizable panelists, who will report more news during their segments:• POV: Penny Jefferson, Director of Coding & Clinical Documentation Integrity Services for the University of Davis Medical Center, will share her point of view during the broadcast.• CDI Report: Cheryl Ericson will provide an update on clinical documentation integrity (CDI).• SDoH Report: Tiffany Ferguson, CEO for Phoenix Medical Management, reports on the news that's occurring at the intersection of medical records and federal regulations.• The Coding Report: Christine Geiger will report on the latest coding news.• News Desk: Timothy Powell, ICD10monitor national news correspondent, will anchor the Talk Ten Tuesdays News Desk.

Imagine machine learning and natural language processing deployed to audit claims.Today, it's the new reality.Autonomous coding is dramatically altering the treacherous auditing landscape. So, how can you protect your facility from takebacks?How do you maintain coding excellence to remain compliant?Join this coming Monday, March 16 for the next live edition of the venerable Monitor Mondays Internet broadcast, when senior healthcare analyst Frank Cohen will describe the inner workings of autonomous coding. Cohen will also explain how to survive in today's unforgiving audit landscape, which has become a habitat for advanced technology.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

The rise of third-party payer audits is no secret to healthcare professionals and facilities, but one type of audit has gained particular attention in recent years: the clinical validation audit. Clinical validation audits ultimately lead to a downgrade of a hospital's diagnostic-related group (DRG) payment, but the process by which they reach that result makes them particularly curious. During utilization review, health plans make decisions about the patient's care and, in the case of clinical validation audits, actually make determinations about whether documented medical diagnoses are “clinically valid”. Join us to hear how clinical validation audits work and the rise in provider disputes involving clinical validation audits.Broadcast segments will also include these instantly recognizable panelists, who will report more news during their segments:·      POV: Penny Jefferson, Director of Coding & Clinical Documentation Integrity Services for the University of Davis Medical Center, will share her point of view during the broadcast.·      CDI Report: Cheryl Ericson will provide an update on clinical documentation integrity (CDI).·      SDoH Report: Tiffany Ferguson, CEO for Phoenix Medical Management, reports on the news that's occurring at the intersection of medical records and federal regulations.·      The Coding Report: Christine Geiger will report on the latest coding news.

Healthcare documentation is no longer written for a single audience. Today, the medical record must simultaneously meet federal regulatory requirements and the coverage expectations of individual payers.While these systems often overlap, they originate from different authorities and serve different purposes. One governs compliance and program integrity; the other determines whether services are approved and reimbursed.As prior authorization expands and audit scrutiny intensifies, hospitals are increasingly navigating both systems at once. Understanding the distinction between regulatory documentation standards and payer-driven requirements is becoming essential for aligning clinical workflows, documentation practices, and operational strategy in today's healthcare environment.During the next live edition of the venerable Monitor Monday, the  live Internet broadcast, senior healthcare consultant Penny Jefferson returns to the broadcast to explain what many today are calling the new face of healthcare.Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

It's huge, and serious.Its implications may impact millions, even beyond the halls of healthcare. In fact, it's the eighth-largest healthcare-related cybersecurity breach in U.S. history.In Texas alone, 15.4 million residents were involved – nearly half the state's population. Oregon reports another 10.5 million. Other states are still notifying residents. The final number may climb even higher. The stolen data reportedly includes names, Social Security Numbers, medical information, and health insurance details.Reporting the details of this enormous data breach during the next episode of Talk Ten Tuesdays will be the legendary Rose Dunn, former president of the American Health Information Management Association (AHIMA).Broadcast segments will also include these instantly recognizable panelists, who will report more news during their segments:POV: Penny Jefferson, Director of Coding & Clinical Documentation Integrity Services for the University of Davis Medical Center, will share her point of view during the broadcast.CDI Report: Cheryl Ericson will provide an update on clinical documentation integrity (CDI).The Coding Report: Christine Geiger will report on the latest coding news.News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

The Centers for Medicare & Medicaid Services (CMS) has launched a new initiative titled Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).CRUSH is a sweeping fraud prevention program. In an official news release posted Thursday, CMS reported suspending $5.7 billion in suspected fraudulent Medicare payments, preventing $1.5 billion in DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) billing, revoking more than 5,500 providers' billing privileges, and denying 122,000 claims that failed medical necessity checks.This latest news, including a nationwide DMEPOS enrollment moratorium and a $259.5 million Medicaid funding deferral, signals a decisive shift toward real-time enforcement.What does CRUSH mean for providers, revenue cycle leaders, and compliance teams?Senior healthcare consultant Penny Jefferson will be the special guest during the next live edition of the long-running news and information national podcast Monitor Mondays. Jefferson, the director of clinical documentation integrity (CDI) services for the University of California Davis Medical Center, will report on this new and developing story.The broadcast will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Part II of the groundbreaking Talk Ten Tuesday series concludes as Tami McMasters Gomez returns to share the real-world impact of UC Davis Health's neurodiversity coding internship.In this powerful follow-up, Tami moves beyond the vision and into outcomes — workforce transformation, productivity gains, retention success, and the measurable value of inclusive hiring in HIM.This isn't a theory. It's operational innovation in action.If you care about strengthening the coding workforce, expanding talent pipelines, and redefining what excellence looks like in the healthcare revenue cycle, you won't want to miss this conversation.Broadcast segments will also include these instantly recognizable panelists, who will report more news during their segments:• POV: Penny Jefferson, Director of CDI Services at the University of California, Davis Medical Center, will share her point of view during the broadcast.• SDoH Report: Marie Stinebuck, CEO for Phoenix Medical Management, will report on the latest news concerning the social determinants of health (SDoH).• CDI Report: Cheryl Ericson will provide an update on clinical documentation integrity (CDI).• The Coding Report: Christine Geiger will report on the latest coding news.• News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

Once a relic symbolic of earlier times in medicine, the Inpatient-Only (IPO) List has been added to the junkyard of outdated medical processes and practices. And if you and your team fail to plan and align your system appropriately, you risk major financial, operational, and compliance consequences.The good news: during the next live edition of Monitor Mondays, you'll learn why inpatient status is no longer guaranteed by procedure. You'll also learn how the burden of proof for inpatient care now rests in your documentation, along with what you and your team must do to protect appropriate inpatient admissions. Join us when Dr. Stephanie Van Zandt reveals practical strategies to navigate this new landscape and stay ahead of the curve.Broadcast segments will also include these instantly recognizablepanelists, who will report more news during their segments:·      POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of Davis Medical Center, will share her point of view during the broadcast.·      CDI Report: Cheryl Ericson will provide an update on clinical documentation integrity (CDI).·      The Coding Report: Christine Geiger will report on the latest coding news.·      News Desk: Juliet Ugarte Hopkins, MD will anchor the Talk Ten Tuesdays News Desk.