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…
In the ever-evolving world of health information, few transitions generate as much anticipation and uncertainty as the adoption of a new international classification system. The 11th Revision of the International…
As healthcare continues to evolve in response to technological innovation and changing patient expectations, coding professionals are at the forefront of documenting that transformation. The CPT® 2025 code set, released…
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…
Oregon Health & Science University Hospital is a 576-bed teaching hospital, biomedical research facility and Level I trauma center located on the campus of Oregon Health & Science University in…
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,…
The Centers for Medicare & Medicaid Services (CMS) has launched the Fraud Detection Operation Center (FDOC) to fight waste, fraud and abuse, the agency announced this week. Listed on a…