When denials are not justified, coding compliance auditors participate in the preparation of appeals using the content of the medical record and official reference materials that justify the coding that was submitted. Discover more about the important role coding compliance auditors play in denials management. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
After the Medicare Payment Advisory Commission reviewed draft recommendations for 2026 payment updates, which included increases only for hospital inpatient and outpatient services, the commission was urged by the American Hospital Association to revise the recommendations. Learn what AHA is recommending instead before the commission meets again tomorrow morning.
Anemia is a complex condition to manage clinically and document accurately, yet proper diagnosis, documentation, and coding are critical for ensuring appropriate patient care and reimbursement. Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP , explores the clinical aspects of anemia, including its definitions, types, causes, and management, while addressing the challenges in clinical documentation and coding.
When coding level-based evaluation and management services based on medical decision-making, the amount and/or complexity of data to be reviewed and analyzed is one element that may be used to reach a code. This article covers what that entails. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Telehealth rules and requirements from before the COVID-19 public health emergency were restored on January 1, 2025, but CMS will hang on to a few waivers. This article outlines several telehealth waiver extensions, as well as recent changes to telehealth law.
A study recently published in JAMA Network Open examined the effects of outpatient rehabilitation programs for patients with post-COVID-19 condition. Find out how the patients benefited from these programs.
The 2025 CPT code set includes new codes for synchronous audio-only and audio-video visits. These visits take place between a patient and a physician or other qualified healthcare professional. This article covers what you need to know about these new codes.
Although advancements in treatment and early detection improve survival rates, the incidence of cancer diagnoses, including lymphoma, continue to rise. To reflect the growing number of cases and the complexity of neoplasms, new ICD-10-CM codes were introduced for fiscal year 2025. Learn how to capture each diagnosis with greater precision.
Prolonged service codes give practices the opportunity to earn additional revenue when the treating clinician spends extra time on a patient’s care. Evaluation and management (E/M) office visit codes include prolonged service code for exclusive use with office E/M services. Learn some quick facts about prolonged service codes and E/M visits.
Follow the career journey of Patricia Shirley, CPC-I, CPC , who started as a front office staff member and advanced through billing and coding roles before transitioning to the CDI field. Her experience highlights the benefits of adaptability and continuing education, demonstrating how a solid foundation in coding and compliance can help improve patient care and ensure accurate clinical documentation.
To align subcategories for diagnosis coding with the DSM-5 classification subcategories for feeding and eating disorders, new ICD-10-CM codes were added in the FY 2025 update. Nancy Reading, RN, BS, CPC, CPC-P, CPC-I , reviews the clinical criteria for affected disorders, including anorexia nervosa, bulimia nervosa, binge-eating disorder, pica in adults, and rumination disorder.
Physicians and other qualified healthcare professionals have the flexibility to select an evaluation and management level based on either the complexity of medical decision-making or the total time spent on the date of the encounter. This article covers documenting E/M services based on time.
Patients diagnosed with a malignant neoplasm, commonly known as cancer, are now living longer due to better treatments. In 2025, there are 47 new ICD-10-CM codes to be used to report lymphoma in remission. This article broadly reviews those new codes.
The major revisions to the coding guidelines for office/other outpatient evaluation and management visits are almost four years old. And yet, practices continue to face challenges when they document and report these services. This article outlines four actions to avoid and four challenges that practices face when they report these high-value, high-volume services.
Physicians and other qualified healthcare professionals have the flexibility to select an evaluation and management level based on either the complexity of medical decision-making or the total time spent on the date of the encounter. This article covers documenting E/M services based on time. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Black Book Research recently surveyed more than 4,000 health information management professionals about their concerns for the new year. Find out what issues are at the top of their minds for 2025.
