Achieving Compliant Medicare Billing By Focusing On What Government Monitors Focus On
Published: Wed, 10/29/25
Updated: Wed, 10/29/25
Link to all things medical coding & billing
Achieving Compliant Medicare Billing By Focusing On What Government Monitors Focus On
With so much focus within the federal government on abuse, fraud, and waste, I thought it might be helpful to review a couple of federal compliance requirements that are directly applicable to clinical documentation integrity (CDI) and coding professionals. The Office of Inspector General...
Weight loss can indicate a variety of health conditions, from minor nutritional changes to serious medical disorders. For healthcare providers, accurately documenting this symptom isn’t just important for clinical care; it’s also critical for reimbursement. That’s where ICD-10 coding comes in. Assigning the correct ICD codes ensures claims...
When Two CMS Factions Interpret Identical Facts Differently
There are times when the Centers for Medicare & Medicaid Services (CMS) doesn’t agree with itself. I am dealing with a situation in which one team at CMS is saying the No Surprises Act (NSA) applies, and another is saying it doesn’t. One of my clients in Florida received an inquiry from CMS. Like many Sun Belt facilities, this organization frequently gets...
America’s healthcare system is heading toward a breaking point. By 2030 the US will face a shortage of more than 86,000 physicians. Hospital margins are razor thin, especially in rural communities, and federal plans call for more than one trillion dollars in Medicaid cuts over the coming decade. In this environment, hospital leaders are racing to adopt...
For decades, armies of medical coders have served as the translators of American healthcare, converting physician notes and hospital encounters into ICD, CPT®, and HCPCS codes that power reimbursement, compliance, and analytics. But as artificial intelligence (AI) becomes more capable, faster, and cheaper, the writing on the wall is clear: medical...
Today’s topic is in reference to a coder question posed about discharge status for inpatients who are waiting for discharge to a nursing home. The questioner noted the possibility of discharging to outpatient status while waiting for nursing home placement. The information request also noted not being able to find any rules that apply to this...
