Interoperability in healthcare moving forward despite challenges

Published: Mon, 09/23/24

Updated: Mon, 09/23/24

Link to all things medical coding & billing

Interoperability in healthcare moving forward despite challenges

Interoperability has been a longstanding goal for healthcare: The promise of being able to exchange data seamlessly between health information networks has been a goal the industry has been working toward for years, and now payers and healthcare organizations have to wrangle with rules, passed by the Centers for Medicare and Medicaid Services...

Are CDI Programs Operating at the Top of Their Game?

The clinical documentation integrity (CDI) profession began its heyday in 2008, with the advent of the Medicare Severity Diagnosis-Related Group (MS-DRG) system that built and expanded upon the simpler system consisting of DRGs with complications and comorbidities (CCs) or major CCs (MCCs) and those without.

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...

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