Understanding the Totality of the Record
A member of a message board I follow, and to which I occasionally contribute, recently posed a question about a denial of coverage based on an alleged failure to meet medical necessity requirements. The admitting diagnosis was metabolic encephalopathy. She did not say (nor, regrettably, did
I ask) the principal diagnosis submitted with the claim.
ICD-11 Officially Released for Implementation
On Feb. 11, the World Health Organization (WHO) released ICD-11 2022. This is the official version of the 11th revision of the International Classification of Diseases (ICD) coding set that WHO member countries will be implementing worldwide. In fact, according to the WHO release
announcement, 35 countries are already using ICD-11.
How NLP Engines are Fulfilling AI’s Promise in Healthcare
In an ideal world, the healthcare industry would be the perfect arena for unleashing the transformative potential of artificial intelligence. Sophisticated AI models require vast amounts of data to learn from, and healthcare data represents nearly
one-third of all data in existence. Nevertheless, all that information could fuel the development of algorithms capable of detecting and diagnosing disease, prescribing preventive...
Public health, hospital leaders open to looser COVID restrictions as cases and hospitalizations decline
COVID-19’s omicron surge is loosening its grip on many of the country’s hospitals, leading several states to relax mask requirements and other restrictions. According to Centers for Disease Control and Prevention (CDC) data, new hospital admissions of patients
with confirmed COVID-19 nationwide have steadily dropped nearly 44% from their peak seven-day average of 21,622 on Jan. 15 to 12,099 as of Feb. 6.
CMS Updates Important Message from Medicare Instructions
The staff at the Centers for Medicare & Medicaid Services (CMS) have been working overtime for the last two years. I have noted before their amazing efforts during the COVID-19 public health emergency (PHE), revising and nuancing the regulations to allow
medical care to continue to be provided to patients. But at the same time...
Telehealth, EHR Use Increases False Claims Act Violations, Fraud
Healthcare digitization, including increased use of telehealth and EHR has led to a higher volume of healthcare fraud and False Claims Act (FCA) cases, according to lawyers from Hogan Lovells.
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