Looking Ahead: 2025 Medicare Auditing: Key Changes and Trends

Published: Thu, 01/09/25

Updated: Mon, 01/13/25

Link to all things medical coding & billing

Looking Ahead: 2025 Medicare Auditing: Key Changes and Trends

The Medicare and Medicaid provider auditing process is about to get a makeover in 2025. I am talking about artificial intelligence (AI), which may be more accurate than our auditors, pre-2025. The Medicare provider auditing process has evolved significantly in recent years, and several key trends are expected to shape the landscape in 2025. These changes are...

Coding Challenge: Understanding Underdosing

While underdosing is no longer a new concept in coding it remains a common area of confusion. Underdosing is when a patient takes less of a medication than is prescribed. Our underdosing codes are found at Z91.1, Patient’s noncompliance with medical treatment and regimen. That makes sense since that is exactly what we are assigning...

Understanding the Finer Points of the Two-Midnight Rule

Few topics crop up in our articles more often than the Two-Midnight Rule. While it is frequently discussed and debated, I would posit that few regulations are easier to explain. For both patients with traditional Medicare and those who elected to be in a Medicare Advantage (MA) plan, if two things are true, the patient should be admitted as an inpatient.

CMS OPPS Proposed Rule: Considerations for Social Drivers in Outpatient Settings

If you’ll recall, a couple of weeks ago, I reported on the Centers for Medicare & Medicaid Services (CMS) Proposed Rule for the social determinants of health (SDoH) in the outpatient settings, specifically Hospital Outpatient Departments (HOPDs), Rural Emergency Hospitals (REHs), and Ambulatory Surgical Centers (ASCs).

HIPAA Changes Providers Need to Heed

Here are some important HIPAA reminders and updates. First, on the Security Rule side of things: this past Thursday, the U.S. Department of Health and Human Services Office for Civil Rights posted its latest settlement with a covered entity related to alleged HIPAA violations. This $250,000 settlement, with a Washington-based healthcare provider...

2025 ICD-10-CM Codes Are Now in Effect: Key Updates You Need to Know

The 2025 updates to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) are now in effect, running from October 1, 2024, through September 30, 2025. While perhaps not as eagerly awaited as a Taylor Swift album drop, these changes are essential for healthcare professionals and providers to understand.

P.O. Box 3824
Youngstown OH 44513
USA

Unsubscribe | Change Subscriber Options