Why it’s Important to Understand Medicare and Medicaid Exclusions and Preclusions

Published: Fri, 09/22/23

Link to all things medical coding & billing

Why it’s Important to Understand Medicare and Medicaid Exclusions and Preclusions

In the post-public health emergency (PHE) era, I have noticed what I think may be a glitch in the computer system at the Centers for Medicare & Medicaid Services. Let me give you the facts, and you can decide whether it’s a glitch, human error, or a conspiracy against Medicare and Medicaid...

How Artificial Intelligence is Leveling the Playing Field for E&M Coding

It’s certainly not breaking news that artificial intelligence (AI) is making inroads in healthcare. Nearly every new article on the topic seems to describe how AI is doing the work that heretofore was being accomplished by humans: nurses, administrators, lab technicians, and coders.

2024 CPT Code Set Released: 5 Key Takeaways

Knowledge of coding updates is essential for everyone from the biller to the revenue cycle leader.

The 2024 CPT code update includes hundreds of new codes and a push for more inclusivity for certain patients. As denial prevention and accurate reimbursement weigh heavy on revenue cycle...

Is Greater UR-CDI Integration on the Horizon?

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 and case management being left in the hospital, I can’t tell you how often Dr. Erica Remer and I are asked to speak...

Learn the rules of coding with time

The AMA (they own the CPT code set) in January of 2021 changed the criteria for determining the proper code level of evaluation and management (E/M) services. Currently, you would use either medical decision–making or time to establish the correct E/M code level. Now before someone in the back gets...

CMS Sends Up Warning Flare on Discharge Planning

Back in June, the Centers for Medicare & Medicaid Services (CMS) released a memo titled “Requirements for Hospital Discharges to Post-Acute Care Providers,” which was sent to survey agencies that received no notice at all. Fortunately, I came across it and can now share it with everyone. But...

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