AI is no longer a distant concept in medical coding and health information management; it is already part of daily work. For many professionals, daily encounters with AI bring a mix of curiosity, caution, and concern.
CMS published the calendar year 2027 Medicare Physician Fee Schedule (MPFS) proposed rule with policies and code changes affecting physician reporting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Train your coding and clinical teams to think like an auditor before you report modifier -25. Improper payments associated with the modifier have triggered more audits and a variety of attempts to detect and recoup improper payments or stop payments from being issued in the first place.
Early outpatient follow-up was not associated with differences in hospital-free survival or risk of decline in health-related quality of life among older adults after acute myocardial infarction, according to a retrospective study published in the Journal of Hospital Medicine.
The 2027 OPPS and ambulatory surgical center proposed rule includes a policy that aims to expand CMS’ method of controlling unnecessary increases in the volume of outpatient services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Established in 2000, the inpatient-only list has served as a catalog of procedures that can only be reimbursed by Medicare when performed in the inpatient setting. However, thanks to technological advancements and new surgical techniques, many of these services can now be performed in hospital outpatient departments and ambulatory surgical centers.
Accurately telling the patient’s story requires a thorough review of the entire medical record to identify all conditions that were addressed during the encounter, whether directly or indirectly, by the provider.
Q: A patient is in the office today being seen for abdominal pain six days post-op of removal of a benign tumor. After ultrasound, cholecystitis is diagnosed and the patient is scheduled for surgery the next day. Is it appropriate to use modifier -24 in this case?
Practices and revenue cycle management companies that report obstetric services must be ready to report under the new CPT guidelines for maternity care services by September 1, according to John Horton, MD, FACOG, vice chair of the committee on health economics and coding for the American College of Obstetrics and Gynecology.
Rule changes regarding cellular tissue–based products restructured Medicare’s reimbursement strategy for these products. This article covers some related challenges.
Arthroscopic knee surgery allows orthopedic surgeons to inspect the inside of the joint and make a variety of repairs without having to perform open surgery. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently published the fiscal year 2027 ICD-10-CM code set for discharges and patient encounters occurring from October 1, 2026 through September 30, 2027.
A coding audit may be conducted by internal staff or external entities, typically representing the insurers paying for the care. When planning to implement a coding auditing program, the type of reviews, focus areas, and review frequency must all be taken into consideration. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
An angiography is a surgical intervention involving the vessels. In angiography procedures, catheters are manipulated into the body to the site of the procedure, dyes are injected, and images are taken.
An outpatient care model designed to serve high-cost Medicaid patients was found to significantly reduce healthcare spending, hospital admissions, and emergency department visits, according to a study published in The American Journal of Managed Care.
