H.R. 1 doesn’t directly rewrite ICD-10 or CPT, but it does change the environment in which you’re coding. The impact is mostly indirect – through eligibility, documentation, the social determinants…
Let me start with the two big news items. First, Nina Youngstrom, the editor of the Report on Medicare Compliance, actually got a response from the Centers for Medicare &…
Once again, a well-known consulting organization has mischaracterized the “incident-to” requirements. A few months ago, I wrote about an article that asserted you can’t bill “incident to” when the patient…
Lots of things happening last week for me to talk about. First, still no sign of the 2026 Outpatient Prospective Payment System (OPPS) Final Rule. Many of us expected a…
The 2026 Medicare Physician Schedule Final Rule includes several distinct policy changes in which the Centers for Medicare & Medicaid Services (CMS) modifies how it uses or pays for services…
The global AI in medical coding market is projected to reach USD 8.4 billion by 2033, rising from USD 2.4 billion in 2023. A CAGR of 13.6% is anticipated during…
In today’s data-driven world, accurate and efficient medical coding is essential for patient care, insurance claims, and regulatory compliance within the healthcare system. However, manual medical coding can be time-consuming,…
When a patient leaves the hospital against medical advice (AMA), the discharge is not only a clinical concern, but it can also create coding and compliance challenges. Ensuring the process…
Weight loss can indicate a variety of health conditions, from minor nutritional changes to serious medical disorders. For healthcare providers, accurately documenting this symptom isn’t just important for clinical care;…
The Coming Storm in Healthcare Finance America’s healthcare system is heading toward a breaking point. By 2030 the US will face a shortage of more than 86,000 physicians. Hospital margins…
For decades, armies of medical coders have served as the translators of American healthcare, converting physician notes and hospital encounters into ICD, CPT®, and HCPCS codes that power reimbursement, compliance,…
Today’s topic is in reference to a coder question posed about discharge status for inpatients who are waiting for discharge to a nursing home. The questioner noted the possibility of…
Let’s start with some updates. We have all been Program for Evaluating Payment Patterns Electronic Report (PEPPER)-free for quite a while now, but I can report that there is finally…
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…
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…