Hospitals want CMS to correct MA plan policies on coverage

The American Hospital Association is asking the Centers for Medicare and Medicaid Services to crack down on Medicare Advantage insurers it says are blatantly flaunting CMS coverage rules. "We expressed…

Comments Off on Hospitals want CMS to correct MA plan policies on coverage

Beware: Recent Changes to MDS Could Cause Audits

Recent changes to the minimum data set (MDS) assessment and recent audit activity targeting skilled nursing facilities (SNFs) appear to be an emerging issue.  As a reminder, the MDS assessment…

Comments Off on Beware: Recent Changes to MDS Could Cause Audits

Feds propose rule changes for No Surprises Act

Federal policy makers aim to revise the billing dispute resolution process in the No Surprises Act (NSA). The administration of President Joe Biden and the U.S. Departments of Health and…

Comments Off on Feds propose rule changes for No Surprises Act

Staying Current with Medical Necessity

A new quarter began on Oct. 1, an event that usually brings updates to National Coverage Determinations (NCDs). The coding updates included for Oct. 1 are specified in Change Request…

Comments Off on Staying Current with Medical Necessity

Is Greater UR-CDI Integration on the Horizon?

There has been growing interest in the intersection of utilization review (UR) and clinical documentation integrity (CDI). With greater recent changes, such as more UR and CDI staff going remote…

Comments Off on Is Greater UR-CDI Integration on the Horizon?

Learn the rules of coding with time

Using time to determine evaluation and management code levels THE AMERICAN MEDICAL ASSOCIATION (they own the CPT code set) in January of 2021 changed the criteria for determining the proper…

Comments Off on Learn the rules of coding with time

Coding Medical Records – A Comprehensive Guide

In the ever-evolving world of healthcare, medical coding plays a crucial role in capturing and organizing patient data for various purposes, including medical billing, research, and quality assessment. Coding medical…

Comments Off on Coding Medical Records – A Comprehensive Guide

Must We Wait for The Pathology to Code Malignancy?

This article was inspired by an article I read by Cynthia Tang and Richard Pinson (https://libmaneducation.com/coding-of-possible-malignancy-diagnoses-when-the-pathology-report-is-pending/). They expressed their concern about Coding Clinic’s advice to code an uncertain malignancy diagnosis…

Comments Off on Must We Wait for The Pathology to Code Malignancy?

10 common issues with medical billing and how to resolve them

Navigating the complex terrain of medical billing can be fraught with expensive and frightening pitfalls. From minor transcription errors to major coding misunderstandings, mistakes in this area can result in…

Comments Off on 10 common issues with medical billing and how to resolve them

What will the next generation of medical coding look like?

A transformation is underway in medical coding as automation permeates medical billing. It raises many questions, such as what kind of skill sets will be needed for this new generation…

Comments Off on What will the next generation of medical coding look like?

Supreme Court Issues Landmark FCA Ruling

The U.S. Supreme Court ruled on a False Claims Act (FCA) case last week. As you probably know, the FCA makes it illegal for a healthcare provider to submit for…

Comments Off on Supreme Court Issues Landmark FCA Ruling

Moving The Needle In Healthcare: From Price Transparency To Automation

The last several years have been tumultuous for the healthcare industry. Providers are continuing to face challenging profit margins, increased costs, staffing shortages and burnout. At the same time, consumers…

Comments Off on Moving The Needle In Healthcare: From Price Transparency To Automation