Talk Ten Tuesdays

Coding reviews reveal more than coding errors and omissions. They can uncover missed opportunities to strengthen provider documentation, identify problematic EHR templates, and recognize overlooked but valid sources of documentation that support code assignment. Drawing from actual coding reviews, special guest Pamela Scott will share interesting findings that demonstrate how looking beyond coding...

Why do patient status programs still struggle? Despite experienced utilization teams, inconsistency is incessant. During the next edition of Talk Ten Tuesday, Dr. Juliet B. Ugarte Hopkins, Chief Medical Officer of Phoenix Medical Management, will explain why clinician education is essential to compliance, accurate status decisions, and sustainable reimbursement. She will highlight the Medicare Two...

She was America’s songbird. A sassy lady whose voice was her claim to fame. She was revered and loved. Her upbeat, joyful attitude brought thousands of Americans to their feet whenever she sang. With her trademark blonde hair and statuesque silhouette frame now gone, she continues to live on as an American icon. The legendary Rose T. Dunn, twice the CEO for the American Health Information Manageme...

The Fifth Universal Definition of Myocardial Infarction (MI), better known colloquially as a heart attack, has replaced the previous Type 1-5 clinical classification with primary, secondary, and procedure-related MI. Yet the ICD-10-CM Final Rule for the 2027 fiscal year (FY) retains the existing numerical MI types, creating an obvious and daunting mismatch. What’s a coder to do? It’s a question Ka...

Angela Comfort is a prominent national healthcare executive who, for more than 30 years, has achieved recognition as a revenue cycle integrity specialist for her work at Montefiore Hospital in New York. Today, she is the president of the American Health Information Management Association (AHIMA), an undisputed leader in the world of healthcare associations. In a rare, unscripted conversation durin...

The gavel came down at last Tuesday’s Coordination and Maintenance Committee meeting—and professional coders wasted no time digging into the new codes and critical updates that will help their colleagues stay ahead in the fast-changing world of coding. Now, ICD10monitor is bringing those timely insights directly to coders and HIM professionals. If you missed the meeting, this is your chance to cat...

Clear, rationale-based documentation in utilization review (UR), especially for status recommendations by physician advisors, is essential. During the next edition of Talk Ten Tuesdays, Dr. Juliet Ugarte Hopkins, Chief Medical Officer for Phoenix Medical Management, Inc., will explain why one-word descriptors such as “inpatient” or “observation” are insufficient when cases are later reviewed, deni...

The American Health Information Management Association (AHIMA) and the Association of Clinical Documentation Integrity Specialists (ACDIS), an HCPro professional community, have released the 2026 update to Guidelines for Achieving a Compliant Query Practice. The practice brief’s guidance applies equally across inpatient, outpatient, ambulatory, and professional fee environments, with specific cons...

The Center for Disease Control and Prevention (CDC) along with the National Center for Health Statistics (NCHS) jointly announced the agenda of its September 15-16, 2026, Coordination and Maintenance committee meeting. During the live event, the public can view and provide feedback on proposed amendments to the International Classification of Diseases, 10th Edition (ICD-10), Clinical Modification...

Like the virtual line between actors and the audience, an invisible line exists between doctors and patients. Yet, Dr. Juliet B. Ugarte Hopkins will explore the sharp contrast in how pediatric and adult medicine address patient pain and fear. Reflecting on her own career choices and a lifelong needle phobia stemming from childhood medical experiences, Dr. Ugarte Hopkins will highlight how pediatri...

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...

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 essenti...

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 expert...

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...

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 broa...

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, th...

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 a...

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, re...

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 fo...

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 nex...

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, fou...

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) audienc...

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 su...

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...

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 HCPr...