While underdosing is no longer a new concept in coding it remains a common area of confusion. Underdosing is when a patient takes less of a medication than is prescribed. …
Few topics crop up in our articles more often than the Two-Midnight Rule. While it is frequently discussed and debated, I would posit that few regulations are easier to explain.…
If you’ll recall, a couple of weeks ago, I reported on the Centers for Medicare & Medicaid Services (CMS) Proposed Rule for the social determinants of health (SDoH) in the…
Interoperability has been a longstanding goal for healthcare: The promise of being able to exchange data seamlessly between health information networks has been a goal the industry has been working…
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…
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…
Today I would like to elaborate on recent remarks from Colleen Ejak regarding the 2025 Outpatient Prospective Payment System (OPPS) Proposed Rule regarding quality metrics and the inclusion of the…
In recent years, generative artificial intelligence (GenAI) has passed medical exams, diagnosed complex cases, and even come up with ways to combat a pandemic. In fact, large language models (LLMs) such as…
The proposed new Medicare billing codes in the proposed Physician Fee Schedule (PFS) for 2025 include three specific codes for digital mental health treatment (DMHT) relating to professional services involving…
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…
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.,…
Current treatment for traumatic arterial injury of the extremities consists primarily of replacement with autologous venous or synthetic graft. However, the need for emergent repair or the unsuitability of a…
The American Medical Association’s coding panel, which is responsible for creating medical billing codes, is set to meet September 19-21 in Albuquerque where it will consider yet another proposal to…
An unprecedented number of individuals are now enrolled in Patient Protection and Affordable Care Act (PPACA) Marketplace health insurance plans – and federal officials this week signaled that the trend…
While CMS (the Centers for Medicare & Medicaid Services) usually releases new rules in the afternoon, on July 10 they chose to release the 2025 Outpatient Prospective Payment System (OPPS)…
A recent proposal to report prior authorization to insurance plans through CPT codes was withdrawn at the eleventh hour when its physician advocate made an unexpected discovery: For certain codes…