Every coder eventually faces the gap: the clinical picture in the record clearly suggests something the documentation never quite says. The bridge across that gap is the physician query —…
The National Correct Coding Initiative is the invisible referee on nearly every multi-code claim — and the source of some of the most persistent confusion in professional-fee billing. Understanding how…
Few two-digit strings generate as much payer attention as modifier 25 — the flag for a significant, separately identifiable E/M service performed by the same practitioner on the same day…
Every October 1, the diagnosis code set changes — and every October, some organizations sail through while others spend the fourth quarter working denials they created themselves. The difference is…
Every practice has a denial rate. The difference between healthy and struggling revenue cycles isn't whether denials happen — it's what happens next. Too many organizations treat denials as write-off…
Most denials aren't caused by exotic coding errors. They're caused by ordinary gaps between what happened in the exam room and what made it into the record. With the 2026…
The CPT 2026 code set, effective January 1, 2026, delivered 418 total changes — 288 new codes, 84 deletions, and 46 revisions. That's a lot to absorb, so here's a…
If you code diagnoses for a living, the fiscal year 2026 ICD-10-CM update — effective for discharges and encounters from October 1, 2025, through September 30, 2026 — is one…
When I first walked into the revenue cycle department of a midsize outpatient clinic in Raleigh, I expected to see stacks of patient charts and billing ledgers. What I found…
In today’s data-driven world, accurate and efficient medical coding is essential for patient care, insurance claims, and regulatory compliance within the healthcare system. However, manual medical coding can be time-consuming,…
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;…
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…
Physicians are asking for greater certainty around Medicare reimbursement, arguing that compounding payment decreases over time have drastically increased the pressure on practices. Industry organizations, individual physicians and others weighed…
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…
The robots aren’t coming. They’re already here. Last week, I had a chat with my accountant, a 45-year veteran who said his son's job just got replaced by ChatGPT. I…
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…