HIPAA Changes Providers Need to Heed

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…

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Are CDI Programs Operating at the Top of Their Game?

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…

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OIG – What Were You Thinking?

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…

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LLMs are not ready to automate clinical coding, says Mount Sinai study

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…

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CMS reports over 12,000 No Surprises Act violations 

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…

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Codes G2211 and GIDXX – Continued Uncertainty

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…

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Understanding the Perils of the 60-Day Refund Rule

The 60-day Refund Rule, created by the 2010 Patient Protection and Affordable Care Act (PPACA), requires providers to report and return Medicare and Medicaid overpayments within 60 days of identifying…

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2024 Coding Clinic 2nd Quarter: COPD and Z79

Chronic obstructive pulmonary disease, (COPD), is an overarching term for conditions which cause difficulty breathing, specifically from some type of impediment to air movement. The two main types are emphysema…

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A ‘TsunamAI’ Of Change Is Coming To Healthcare

In the last 50 years, there have been significant developments that have forever improved the delivery of healthcare. Consider imaging (MRI/CT scans), minimally invasive surgery, anti-viral therapies, precision medicine (e.g.,…

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