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…
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…
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…
As the healthcare industry continues to evolve in 2025, the demand for skilled medical billers and coders has reached unprecedented levels. This growth is fueled by ongoing changes in healthcare…
Like many of you, I am deathly allergic to clinical documentation integrity (CDI), but do not worry; I premedicated with prednisone and an antihistamine prior to writing this article. I…
Clinical documentation integrity (CDI) has matured beyond its initial focus on coding accuracy and Diagnosis-Related Group (DRG) optimization. In 2025, it is central to payer compliance, audit defense, risk adjustment,…
As the healthcare industry changes, there needs to be a shift from a growth perspective to an efficiency perspective. Most hospitals had their highest case mix index (CMI) during COVID,…