What a medical coder looks for in an AI platform

Published: Thu, 01/16/25

Updated: Thu, 01/16/25

Link to all things medical coding & billing

What a medical coder looks for in an AI platform

Dawson Ballard, a coding auditor and educator for Chicago-based Rush University Medical Center who has more than 20 years experience in the profession, sees artificial intelligence coding platforms as beneficial. “It’s not foolproof, but it can certainly increase productivity,” he told Becker’s. Going the way of AI is a reality for health systems, but it is...

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...

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