Talk Ten Tuesdays

Anyone who has been working within the scope of hospital case/utilization management for any period of time has heard of the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation.

But are you familiar with the CMS Conditions for Coverage?  Sometimes referred to as “conditions of payment,” these requirements must be met in order for federal health plans to pay a healthcare facility for a submitted claim.

Welcome...

They were once called “clinical documentation improvement” specialists, charged with correcting the medical record to identify an overlooked diagnosis that carried the potential to increase revenue. Later, the description was changed to clinical documentation “integrity” (CDI) specialists. 

But that was then. This is now.

Today, the job description continues to change. CDI professionals are being asked to take on more and more respon...

Since 80 percent of a person’s health is influenced by factors outside of medical care, it is critical that a healthcare system has an understanding and appreciation for the circumstances of patients’ daily lives that impact their health outcomes, referred to as the social determinants of health (SDoH). 

During the next live edition of Talk Ten Tuesday, Lauren Montwill, Vice President of Community Health and Social Impact ...

It’s often said that “words matter.”

And hospital patient status assignment is no exception. 

What do your teams say when a patient is in inpatient status which isn’t supported?  How about the reverse: when a patient is in outpatient status with observation services. Can your team change to inpatient? 

Words matter, and Dr. Juliet Ugarte Hopkins, chief medical officer for Phoenix Medical Management, Inc., will explain precisely how im...

A new version of the Sequential Organ Failure Assessment (SOFA) score, has been introduced.

The new revision aligns the organ dysfunction measurement in critically ill adults with current clinical practices, especially those diagnosed with sepsis.

Published Oct. 29 in Journal of the American Medical Association (JAMA) and is available here https://jamanetwork.com/journals/jama/fullarticle/2840822.

During the next live edition of Talk ...

Welcome to “Is Ambient Listening Right for You?” Or, in the alternative, “Free AI Tools and Other Expensive Mistakes.”

Nick van Terheyden, MD, the special guest during the next live edition of Talk Ten Tuesdays, says he has seen enough of artificial intelligence (AI) “helpers” turn doctors into unpaid editors and part-time exorcists for hallucinating software.

“Clinicians signed up to heal humans, not debug bots,” Dr. Nick said. “Yet...

H.R. 1, known as the One Big Beautiful Bill Act (OBBBA), is set to reshape hospital finances by cutting an estimated $840 billion from Medicaid and Patient Protection and Affordable Care Act (PPACA) funding. As hospitals absorb these losses, many are tightening budgets, reducing staff, and facing renewed labor tensions.

For the first time, clinical documentation integrity (CDI) teams are part of this unionized landscape, connecting ...

Have you been told that Medicare and Medicare Advantage (MA) patients who have difficulties with activities of daily living (ADLs) are appropriate for inpatient status if their hospital stay crosses a second midnight? 

What direction have you received about “discharge effectuation?” 

Are your physicians keen on placing the majority of their patients into inpatient status because they want to prevent delivery of an expensive hospital ...

Join us this coming Tuesday, Oct. 14, when Talk Ten Tuesday will bring you an exclusive interview with two nationally recognized healthcare leaders: Thea Campbell and Mackenzie Higgins. Thea Campbell is the 2026 AHIMA President-Elect and Mackenzie Higgins is the 2025 AHIMA Emerging Star award recipient.

The popular broadcast will also feature these instantly recognizable panelists, who will report more news during their segments:

The revenue cycle helps keep hospital revenue flowing. But sometimes, it seems to sputter out, as if not all the cylinders are firing. And that is why the producers of Talk Ten Tuesdays have invited longtime ICD10monitor editorial consultant Dennis Jones, senior director of revenue cycle at the famed Jefferson Health, to be the special guest during the next live edition of the weekly Internet radio broadcast.

The popular broadcast w...

When the final rule take effect Oct. 1, 2025, coders, providers, and administration leaders will need to adjust to several key changes, including the new MS-DRGs and broad policy changes. And that is why the producers of Talk Ten Tuesday have invited Leigh Poland, vice president of the AGS Health coding service product line to return to the popular Internet broadcast, Talk Ten Tuesday, to report on these significant changes.

The pop...

Prolonged hospitalizations can result from many different barriers and delays within the hospital setting.

However, a new challenge is emerging.

And this new hurdle appears to be identified more and more commonly. So, what’s happening?

During the next live edition of Talk Ten Tuesdays, Dr. Juliet B. Ugarte Hopkins, Chief Medical Officer at Phoenix Medical Management, Inc., will reveal this new culprit that appears to be standing betwe...

Could sepsis be healthcare’s new frontier?

During the next live edition of the popular Internet broadcast, Talk Ten Tuesday, James S. Kennedy, MD, will report on his recent attendance at The Unite for Sepsis symposium, sponsored by the San Diego-based Sepsis Alliance (https://www.sepsis.org). The event was held in Chicago and attracted clinicians, researchers, technologists, and government officials who collaborated to address and s...

You waited and waited.

Finally, the big day came, and just as quickly, day turned into evening – and there you were with cloudy vision, halos, and difficulty reading. Not to mention the occasional glare.

You and about 25 percent of patients experience a common complication following cataract surgery (or, more precisely, “posterior capsule opacity,” or PCO). The good news: the standard treatment is YAG laser capsulotomy (CPT® 66821).

T...

Artificial intelligence (AI) has quickly transitioned from something to expect in the future to the here and now today. The potential for AI in health information is both exciting and daunting. Reporting the lead story during the next live edition of Talk Ten Tuesday will be longtime RACmonitor and ICD10monitor contributing author Sharon Easterling.

Sharon Easterling will continue her editorial series on artificial intelligence and ...

At one time, a physician advisor in a hospital was a rarity. That was then, but this is now, with many healthcare systems having not just one physician advisor, but often many on staff. Does this emerging need signal the deployment of a new position within the physician advisory service team?

To learn more, ICD10monitor producers have invited Dr. Juliet B. Ugarte Hopkins to explain when and how this might be accomplished.

Dr. Ugarte ...

Although the proposed rule for the 2026 Inpatient Prospective Payment System (IPPS) has been released by the Centers for Medicare & Medicaid Services (CMS), mastering the complexities will continue to challenge most coders and coding team members. That is why ICD10monitor producers have asked Dr. James S. Kennedy to join the upcoming edition of Talk Ten Tuesdays: to highlight potentially significant roadblocks that are likely t...

During the next live edition of the popular Talk Ten Tuesday Internet broadcast, you’ll learn how artificial intelligence (AI) and autonomous coding are quickly reshaping the day-to-day work of coders.

From inpatient DRG suggestions to outpatient evaluation and management (E&M) automation, these tools speed up workflows, reduce errors, and help prevent costly denials, according to Penny Jefferson, the special guest for the Inter...

According to the Centers for Disease Control and Prevention (CDC), accidental falls are the leading cause of injury for adults 65 and older, with more than 1 in 4 older adults reporting falls every year.

During the next live edition of Talk Ten Tuesday, Dr. James S. Kennedy will discuss the clinical concept of the “fragility fracture,” and how the under-documentation of fragility fractures results in inaccurate ICD-10-CM coding, adv...