Medical experts have put on hold a proposal to create new billing codes for prior authorizations. The American Medical Association’s CPT (current procedural terminology) Editorial Panel was scheduled to meet…
Medicare Advantage plans have come under fire for upcoding that can increase the payouts they receive, and regulators point to health risk assessments as a likely culprit in this increase…
Is there an arms race involving using technology for submitting claims and auditing them? In one example, an electronic health record system was deployed that would increase reimbursements. It would…
The rapid adoption of telehealth services, accelerated by the COVID-19 pandemic, has had a positive result on outcomes and resulted in a boost in healthcare spending, according to a report…
A recent study from the healthcare solutions company Premier indicated that $19.7 billion is what hospitals and health systems are spending annually on handling and appealing denials. Yes, that is…
Legal scholars, practitioners, and other observers have grappled with the legal dimensions of artificial intelligence (AI). As early as 1992, Solum discussed the case for considering AI to be a…
As we know, artificial intelligence (AI) is in the spotlight these days. It is being adopted in almost every sector of the economy. It is a commercial product, and the…
The Centers for Medicare & Medicaid Services (CMS) has issued its 2025 Inpatient Prospective Payment System (IPPS) Proposed Rule, through which it proposes to change the severity designation for several…
The US is approaching a crossroads regarding the diagnostic coding system that is used in all patient records and information exchanges that support patient care, research, quality measurement, and payment.…
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…
CMS recently released a web-based validation tool that assists hospitals with price transparency compliance. The updated V2.0 Online Validator Tool helps hospitals develop machine-readable files to comply with a federal…
On March 27, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for Inpatient Rehabilitation Facilities (IRFs) that would update payment policies for the 2025 fiscal year…
In the face of ever-rising healthcare costs, technology could offer a reprieve. Indeed, physicians across the country are interested in learning about the potential benefits of AI for themselves and…
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…
Troves of data flow through the healthcare revenue cycle. Yet, many providers struggle to make sense of the codes and clinical documentation to not only submit clean claims but also…
Revenue cycle management performance has never been more important. And recent advances in technology, particularly artificial intelligence, offer much potential for healthcare's administrative functions. The RCM function could lay the…