OIG – What Were You Thinking?

Published: Fri, 09/06/24

Updated: Fri, 09/06/24

Link to all things medical coding & billing

OIG – What Were You Thinking?

While many of you are used to me aiming my wrath at payers, today I have a different target: the U.S. Department of Health and Human Services (HHS) Office of Inspector General (HHS). Yep, the OIG that works with HHS to protect the Medicare Trust Fund from cheaters and thieves. Last week, they released an audit of a Medicare Advantage plan, MMM...

LLMs are not ready to automate clinical coding, says Mount Sinai study

A new study from Mount Sinai suggests that using generative artificial intelligence to help with coding automation has some significant limitations. WHY IT MATTERS. For the research, Mount Sinai's Icahn School of Medicine evaluated the potential application for large language models in healthcare to automate medical code assignments – based on...

CMS OPPS Proposed Ruling Focuses on Social Drivers in Outpatient Settings

Today I would like to elaborate on recent remarks from Colleen Ejak regarding the 2025 Outpatient Prospective Payment System (OPPS) Proposed Rule regarding quality metrics and the inclusion of the social determinants of health (SDoH). The Centers for Medicare & Medicaid Services (CMS) is expanding its SDoH initiatives for quality reporting from the...

CMS reports over 12,000 No Surprises Act violations

The Centers for Medicaid and Medicare Services this week released a report on complaints and enforcement efforts concerning the Public Health Service Act, which includes the No Surprises Act.

As of June 30, CMS received more than 16,073 complaints. Of these, 12,077 were No Surprises Act complaints, with 1,777 being alleged violations...

Codes G2211 and GIDXX – Continued Uncertainty

If you have been listening to the discussions on Monitor Monday and Talk Ten Tuesday about the use of the new HCPCS code G2211, you know there remains some uncertainty on its use. Several weeks ago, the Centers for Medicare & Medicaid Services (CMS) stated that they would be releasing a FAQ document the next week. Well, that period came...

Leveraging Generative and Advanced AI to Transform Coding and CDI – Part 1

In recent years, generative artificial intelligence (GenAI) has passed medical exams, diagnosed complex cases, and even come up with ways to combat a pandemic. In fact, large language models (LLMs) such as GPT-4, Google’s BARD, and BioGPT now perform complex tasks that can completely transform clinical...

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