Talk Ten Tuesdays

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 in...

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 th...

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 evalu...

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 ...

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 mor...

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 Man...

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-...

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 th...

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 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...

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 broadc...

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 strateg...

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...

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)...

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 bo...

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 documentatio...

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 ...

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 ...

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, h...