The Centers for Medicare & Medicaid Services (CMS) has proposed an episodic payment model, the Transforming Episode Accountability Model (TEAM). This is one of CMS’s “innovation” models. If it makes…
As part of the Jan. 1, 2024 Outpatient Prospective Payment System (OPPS) guidelines, caregiver training services (CTS) codes were listed as billable services if provided by physicians and non-physician practitioners…
A recent study from the healthcare solutions company Premier indicated that $19.7 billion is what hospitals and health systems are spending annually on handling and appealing denials. Yes, that is…
The Centers for Medicare & Medicaid Services (CMS) has issued its 2025 Inpatient Prospective Payment System (IPPS) Proposed Rule, through which it proposes to change the severity designation for several…
The US is approaching a crossroads regarding the diagnostic coding system that is used in all patient records and information exchanges that support patient care, research, quality measurement, and payment.…
Troves of data flow through the healthcare revenue cycle. Yet, many providers struggle to make sense of the codes and clinical documentation to not only submit clean claims but also…
When American Medical Association president Dr. Jesse Ehrenfeld takes the stage in San Diego this month during the HIMSS' AI in Healthcare Forum, he brings AMA principles for augmented intelligence development, deployment…
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…
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…
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…
In the ever-evolving world of healthcare, medical coding plays a crucial role in capturing and organizing patient data for various purposes, including medical billing, research, and quality assessment. Coding medical…
Times are tough for physicians. A shortage of doctors, exacerbated by the pandemic, has led to a higher patient-to-physician ratio. More patients equals more administrative work for doctors. This translates…
This article was inspired by an article I read by Cynthia Tang and Richard Pinson (https://libmaneducation.com/coding-of-possible-malignancy-diagnoses-when-the-pathology-report-is-pending/). They expressed their concern about Coding Clinic’s advice to code an uncertain malignancy diagnosis…
Navigating the complex terrain of medical billing can be fraught with expensive and frightening pitfalls. From minor transcription errors to major coding misunderstandings, mistakes in this area can result in…