The American Hospital Association is asking the Centers for Medicare and Medicaid Services to crack down on Medicare Advantage insurers it says are blatantly flaunting CMS coverage rules. "We expressed…
Well, I suppose I have given you enough of a break from my writing about Medicare Advantage (MA) plans and the Two-Midnight Rule. Last week, United HealthCare (UHC) released its…
Recent changes to the minimum data set (MDS) assessment and recent audit activity targeting skilled nursing facilities (SNFs) appear to be an emerging issue. As a reminder, the MDS assessment…
Federal policy makers aim to revise the billing dispute resolution process in the No Surprises Act (NSA). The administration of President Joe Biden and the U.S. Departments of Health and…
Access to post-acute care remains an issue in most hospitals around the country. Exacerbated by the staffing challenges that worsened during COVID-19, the ability to get a patient transferred to…
A new quarter began on Oct. 1, an event that usually brings updates to National Coverage Determinations (NCDs). The coding updates included for Oct. 1 are specified in Change Request…
Clinicians today are confronted with an increasing administrative burden alongside their patient care responsibilities, and a critical aspect of this burden is medical coding. This skill is crucial as it…
Often called the “language of medicine,” the Current Procedural Terminology (CPT®) code set is always evolving, and one reason for that evolution is to lower the administrative burden for physicians and their…
In the post-public health emergency (PHE) era, I have noticed what I think may be a glitch in the computer system at the Centers for Medicare & Medicaid Services (CMS).…
It’s certainly not breaking news that artificial intelligence (AI) is making inroads in healthcare. Nearly every new article on the topic seems to describe how AI is doing the work…
There are over 300 changes you need to know. KEY TAKEAWAYS Knowledge of coding updates is essential for everyone from the biller to the revenue cycle leader. The 2024 CPT…
There has been growing interest in the intersection of utilization review (UR) and clinical documentation integrity (CDI). With greater recent changes, such as more UR and CDI staff going remote…
Using time to determine evaluation and management code levels THE AMERICAN MEDICAL ASSOCIATION (they own the CPT code set) in January of 2021 changed the criteria for determining the proper…
Back in June, the Centers for Medicare & Medicaid Services (CMS) released a memo titled “Requirements for Hospital Discharges to Post-Acute Care Providers,” which was sent to survey agencies that…
In the ever-evolving world of healthcare coding, professionals must stay abreast of the latest updates to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). This dynamic coding system…
The American Health Information Management Association (AHIMA) regularly publishes practice briefs related to best practices within the health information arena. These briefs serve as references within the industry to guide…