The implementation of the 21st Century Cures Act has resulted in radiology patients in the outpatient setting being able to view their examination results quicker, according to a study published in JAMA Network Open.
A study published in Respiratory Care found that integrating respiratory therapists (RT) in a chronic obstructive pulmonary disease (COPD) clinic led to significant improvements in symptoms and exacerbation rates among patients, as well as a reduction in hospitalizations.
The calendar year 2026 OPPS and ambulatory surgical center (ASC) proposed rule, released on July 15, details payment updates, services covered, outpatient service volume, and quality reporting, among other proposals.
CMS recently released the fiscal year (FY) 2026 ICD-10-CM update, which includes 487 new diagnosis codes effective October 1, 2025. The new codes cover a range of diagnoses, so be sure to review the code update files.
Clients who participated in court-ordered assisted outpatient treatments (AOT) displayed significant improvements across several outcome measures, according to a study recently published in Psychiatric Research and Clinical Practice.
A recent study published in the American Journal of Psychiatry looked into national trends in outpatient mental healthcare and found that the use of psychotherapy increased while the use of psychotropic medication alone decreased.
CMS recently updated the list of preventive service codes that can be reported with complexity add-on HCPCS code G2211. In a recent change request, CMS deleted codes for services not considered covered preventive services and added codes for services that are considered covered preventive services.
While the use of artificial intelligence has begun to change how healthcare organizations process data, large language models have not yet reached the level of sophistication to meet the demands of medical coding, according to an op-ed published by Forbes.
CMS recently published its HCPCS Quarterly Update, which brings 148 HCPCS Level II code additions, discontinuations, and revisions. The changes became effective April 1.
The largest barriers and facilitators to screening, documenting, and addressing adverse social determinants of health across United States’ emergency departments have been identified in a recent study published in JAMA Network Open.
A recent report from the Brown University School of Public Health compared the average commercial price for low-complexity, low-intensity medical care in New York hospital outpatient departments to the same care provided in non-hospital settings, such as physician offices and ambulatory surgery centers.
A recent study published in BMC Public Health, found that patients in Colorado diagnosed with long COVID increasingly sought care from outpatient and specialist visits over hospital and emergency department visits.
CMS recently published diagnosis code update files for discharges and patient encounters beginning on April 1, 2025, and through September 30, 2025. Learn about the revisions featured in the updated files.
The worldwide outpatient clinic market is projected to grow considerably in the next few years. Learn what key factors are driving the increase in demand for outpatient services.
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.
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.
CMS recently issued a proposed rule for 2026 that includes provisions aimed at limiting Medicare Advantage in-network cost-sharing for behavioral health services to be no greater than the traditional Medicare rates. Find out what the proposed behavioral health cost-sharing standards are in the proposed rule.
A recent OIG audit estimates that Medicare improperly paid $190.1 million for outpatient services provided to hospice enrollees over five years. Learn how the audit was performed and why the payments were improperly made.
CMS recently announced updates to the January 2025 Integrated Outpatient Code Editor, including new HCPCS codes and changes to a handful of status indicators.
The American Medical Association recently announced new codes, deletions, and revisions included in the 2025 CPT code set. Explore these notable updates to the code set.
According to a recent analysis, healthcare organizations are submitting more prior authorization requests to Medicare Advantage plans and more of those requests are being denied. Review the analysis’ findings to be more aware of prior authorization processes and CMS’ efforts to streamline them.
Patients who self-reported housing instability often didn’t have the correct ICD-10-CM codes documented in their record, according to a recent study. Review the results of the study and be more aware of the importance of properly documenting housing insecurity to ensure appropriate housing and medical services are delivered.
CMS’ proposed rule to revise the Medicare hospital Outpatient Prospective Payment System for calendar year 2025 has been released. Review some of the proposals that could directly impact your organization.
CMS recently released an updated MLN fact sheet reminding providers about documentation requirements for requests from its Comprehensive Error Rate Testing (CERT) program.
CMS updated its July 2024 HCPCS Quarterly update file in May with a total of 70 new HCPCS codes, 11 discontinued codes, and 32 revised codes. All code changes will be implemented July 1.
The Food and Drug Administration’s (FDA) emergency use authorization for Pemgarda, a pre-exposure COVID-19 prophylaxis, has led to the release of HCPCS Level II codes for the drug and its administration.
CMS published a summary of its first quarter 2024 HCPCS Level II code update application decisions. There were 48 additions, two code definition revisions, and seven discontinuations.
CMS proposed hundreds of ICD-10-CM code changes in the 2025 IPPS proposed rule, published April 10, including 252 new codes, 13 revised codes, 36 invalidated codes.
CMS published its HCPCS Quarterly Update in March, which heralded the sum of 94 HCPCS Level II code additions, discontinuations, and definition revisions. The changes became effective April 1.
The Journal of the American Medical Association (JAMA) published a study in March found that “foot and ankle care was associated with an 11% lower likelihood of death…and a 9% lower likelihood of major amputation (above or below knee).”
CMS retroactively added two new CPT codes for respiratory syncytial virus (RSV) vaccine administration. The codes affect services rendered on or after October 6, 2023.
A JAMA study published in January found that patients with the highest risk for severe COVID-19 infection received outpatient therapy less often than those with the least risk.
CMS published a summary of its fourth quarter 2023 HCPCS Level II code update application decisions, including 36 additions, four revisions, and 18 deletions.
CMS posted its 2024 Therapy Code List and Dispositions on December 28. This list indicates whether therapy services, as distinguished by HCPCS Level II and CPT codes, are recognized under CMS as “sometimes therapy” or “always therapy.”
Michael Lonski, Ph.D., a licensed psychologist, was sentenced to 27 months of imprisonment and three years of supervised release for conducting $2.6 million in Medicare and Medicaid fraud, the Department of Justice announced December 19.
CMS released its January 2024 HCPCS Level II code update December 7, outlining 344 new and 74 discontinued codes. The code changes will become effective January 1, 2024.
A recent Office of Inspector General audit of inpatient and outpatient Medicare claims estimated that nearly 20% of cases including codes for abuse or neglect were not reported to law enforcement.
CMS recently published a summary of its third quarter 2023 HCPCS Level II code update application decisions, accepting 51 of 61 submissions. There were also 10 codes that will be discontinued and one code whose definition will be revised. The additional codes mostly consist of injections and skin substitutes.
CMS estimated $4.4 billion in improper payments in 2022 for hospital outpatient services, according to a Comprehensive Error Rate Test review recently published in the Medicare Provider Compliance Newsletter. According to the report, of the 1,899 inspected claims, 5.4% were improperly paid.
CMS' recently implemented October OPPS update brings with it a slew of new, revised, and deleted CPT and HCPCS Level II codes with effective dates ranging from April 18 to October 1. Among the additions are codes for vaccines, vaccine administration, skin substitutes, renal histotripsy, and breast imaging.
AMA published the 2024 CPT code set with 349 total editorial changes, including 230 additions, 49 deletions, and 70 revisions. The press release announced revisions for immunization/administration sections, E/M clarification, and new Spanish procedure descriptions.
CMS updated its E/M Services Guide in August, reflecting changes for E/M services that went into effect January 1. The guide includes plain-language explanations of policy changes, but some do not align perfectly with AMA guidance.
CMS recently released a national coverage determination update to the Medicare Claims Processing Manual . This update covers new requirements for CPT coding associated with acupuncture and dry needling services.
CMS recently published a summary of its second quarter 2023 HCPCS Level II code update application decisions, accepting 16 of 24 submissions. Many of the changes addressed in the announcement have an effective date of October 1, but one code revision and one code discontinuation will take effect before then.
