When it comes to healthcare policy, even seemingly minor adjustments can have significant ripple effects across the industry. The Centers for Medicare & Medicaid Services (CMS) recently unveiled its proposed…
One of the goals of medical coding is documenting encounter notes to the highest degree of specificity. ICD-10-CM had some existing codes for documenting foreign bodies entering through a natural…
The Star Rating program for hospitals summarizes quality information on important topics, like readmissions and mortality, after admissions for conditions such as myocardial infarction (MI) or pneumonia. The overall ratings…
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…
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…
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…
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…
Clinicians today are confronted with an increasing administrative burden alongside their patient care responsibilities, and a critical aspect of this burden is medical coding. This skill is crucial as it…
It’s certainly not breaking news that artificial intelligence (AI) is making inroads in healthcare. Nearly every new article on the topic seems to describe how AI is doing the work…
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…
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…
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…
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…
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…
A proposed 3.3% cut to physician pay would threaten access to care and efforts to bring more clinical oversight into nursing homes, advocacy groups are warning. A 2024 draft pay…
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…