Dawson Ballard, a coding auditor and educator for Chicago-based Rush University Medical Center who has more than 20 years experience in the profession, sees artificial intelligence coding platforms as beneficial. …
The Medicare and Medicaid provider auditing process is about to get a makeover in 2025. I am talking about artificial intelligence (AI), which may be more accurate than our auditors,…
While underdosing is no longer a new concept in coding it remains a common area of confusion. Underdosing is when a patient takes less of a medication than is prescribed. …
Few topics crop up in our articles more often than the Two-Midnight Rule. While it is frequently discussed and debated, I would posit that few regulations are easier to explain.…
If you’ll recall, a couple of weeks ago, I reported on the Centers for Medicare & Medicaid Services (CMS) Proposed Rule for the social determinants of health (SDoH) in the…
Here are some important Health Insurance Portability and Accountability (HIPAA) reminders and updates. First, on the Security Rule side of things: this past Thursday, the U.S. Department of Health and…
The 2025 updates to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) are now in effect, running from October 1, 2024, through September 30, 2025. While perhaps not…
Interoperability has been a longstanding goal for healthcare: The promise of being able to exchange data seamlessly between health information networks has been a goal the industry has been working…
The clinical documentation integrity (CDI) profession began its heyday in 2008, with the advent of the Medicare Severity Diagnosis-Related Group (MS-DRG) system that built and expanded upon the simpler system…
While many of you are used to me aiming my wrath at payers, today I have a different target: the U.S. Department of Health and Human Services (HHS) Office of…
A new study from Mount Sinai suggests that using generative artificial intelligence to help with coding automation has some significant limitations. WHY IT MATTERS For the research, Mount Sinai's Icahn School…
Today I would like to elaborate on recent remarks from Colleen Ejak regarding the 2025 Outpatient Prospective Payment System (OPPS) Proposed Rule regarding quality metrics and the inclusion of the…
The Centers for Medicaid and Medicare Services this week released a report on complaints and enforcement efforts concerning the Public Health Service Act, which includes the No Surprises Act. As…
If you have been listening to the discussions on Monitor Monday and Talk Ten Tuesday about the use of the new HCPCS code G2211, you know there remains some uncertainty…
In recent years, generative artificial intelligence (GenAI) has passed medical exams, diagnosed complex cases, and even come up with ways to combat a pandemic. In fact, large language models (LLMs) such as…
The proposed new Medicare billing codes in the proposed Physician Fee Schedule (PFS) for 2025 include three specific codes for digital mental health treatment (DMHT) relating to professional services involving…