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…
There are times when the Centers for Medicare & Medicaid Services (CMS) doesn’t agree with itself. I am dealing with a situation in which one team at CMS is saying…
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…
If you’re waiting for the perfect moment to bring AI into your business, here’s a thought: What if your first win isn’t flashy—it’s just functional? Let me show you what…
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 Centers for Medicare & Medicaid Services (CMS) issued its Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule for the 2026 fiscal year this week, and…
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…
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…
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…
As with many other physicians of a certain age, I have had the opportunity to practice patient care in both the worlds of paper and electronic charting. Granted, as a…
The 2025 updates to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) are now in effect, running from October 1, 2024, through September 30, 2025. While perhaps not…