The biggest impacts to clinical documentation integrity (CDI) professionals for the 2026 fiscal year (FY) will not be associated with updates to the ICD-10-CM code set or the Inpatient Prospective…
If you’re waiting for the perfect moment to bring AI into your business, here’s a thought: What if your first win isn’t flashy—it’s just functional? Let me show you what…
While plans are still grappling with last year’s significant changes to The Center for Medicare and Medicaid Services (CMS) 2025 Star Ratings, more change is on the way. The new…
Federal contractors – Recovery Audit Contractors (RACs) and Unified Program Integrity Contractors (UPICs) – have increasingly targeted wound care claims, particularly involving expensive skin substitutes billed under Medicare Part B. In…
The American Medical Association (AMA) introduced 17 new telemedicine evaluation and management (E&M) codes this year. Here’s the breakdown of these new codes: CPT® code range 98000-98007 are reported for…
The robots aren’t coming. They’re already here. Last week, I had a chat with my accountant, a 45-year veteran who said his son's job just got replaced by ChatGPT. I…
The Centers for Medicare & Medicaid Services (CMS) issued its Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule for the 2026 fiscal year this week, and…
In the current climate of cost containment, commercial payers are increasingly downgrading MS-DRGs after claims are submitted, not disputing the need for inpatient care, but questioning the clinical support for…
I think it is important to challenge one portion of an article that was widely distributed two weeks ago. The article included a statement that, while accurately characterizing the way…
An association of health information managers, clinical coders, and clinical documentation specialists in Australia has released a guideline for adopting clinical coding AI solutions. The guideline developed by the Health Information…
Across the industry, health systems are laying the foundation for artificial intelligence success, ensuring they have the infrastructure, governance and technical expertise to make the most of the technology. Organizations…
The first day of summer will be this week, so it’s a good time for a look at some codes we may be assigning. Summertime brings more time outside relaxing…
The Centers for Medicare & Medicaid Services (CMS) recently released its 2026 Medicare Advantage (MA) Rate Announcement (Opens in a new window), projecting a 5.06% average increase in payments to…
As we progress through 2025, the landscape of medical coding is shaped by a wave of new regulations from both governmental and commercial payers. These changes are designed to increase…
Artificial intelligence is fundamentally reshaping medical coding in 2025, offering new levels of accuracy and operational efficiency that were previously unattainable. As regulatory demands intensify and payer audits become more…
Continuing our look at areas where we see confusion we will examine the assignment of the long term use codes for anticoagulants versus antithrombotics/antiplatelets. GoodRx.com, in an article titled, “Antiplatelet…