FINALLY FRIDAY! LIVE
1:00–2:00 PM Eastern / noon–1:00 PM Central
October 1 Is Not Just a Coding Update
Where Hospital Payment Can Break!
Your hospital can load the new codes and still miss the handoff that determines whether a claim is correct.
Let’s find the gap before it becomes another work queue.
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Discussions, not lectures.
Three teaching cases.
One practical checklist.
The problem is not always the code
Did the change reach the claim?
Join Ernie de los Santos for a case-based discussion of the people, records, system rules, and payer requirements that sit between a policy update and the correct payment.
CASE A / INPATIENT
A stay crosses October 1.
An admission starts in September and ends with an October discharge. We separate the version-selection question from the additional facts needed to validate payment.
Which date controls—and who checks the handoff?
CASE B / OUTPATIENT CLAIM
The service is there. The field is blank.
Supported procedure information never reaches the outbound claim. Is the defect in documentation, coding, mapping, edits, or transmission?
Are you testing the screen—or what the payer receives?
CASE C / PAYER WORKFLOW
The payer stopped asking. The queue did not.
A legacy GI notification hold remains in the workflow. We examine how to verify the applicable notice and retire only the obsolete step.
What should your team safely stop doing?
What we will work through...
Less policy recital.
More practical decisions.
- Identify the correct payer, setting, and effective-date trigger.
- Trace discharge and documentation information into the claim.
- Test the actual outbound claim, not just an internal screen.
- Remove obsolete workflow steps without removing necessary safeguards.
- Separate a correct payment change from a claim error, payer error, or denial.
Bring the next department...
The handoff belongs to more than one team.
Built for coding, CDI, UR/UM, case management, patient access, billing, denials and appeals, physician advisors, compliance, reimbursement, and revenue-cycle leadership. Bring a general workflow question and be ready for polls, practical cases, and audience discussion.
Don’t stop at “we updated it.”
Friday, September 25 at 1 PM Eastern / noon Central.
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The replay will be available free through Monday, September 28.
After that, it will be available in the member library.
