Category: Blog

NCDs Affected by ICD-10-CM Medical Necessity Code Changes

NCDs Affected by ICD-10-CM Medical Necessity Code Changes

When ICD-10-CM is updated Oct. 1, so are these National Coverage Determinations. Are you wondering which National Coverage Determinations (NCDs) will be affected by the thousands of diagnosis code changes going into effect Oct. 1? Centers for Medicare & Medicaid Services (CMS) transmittal tells all. CMS Transmittal 11546, issued Aug. 4, is a one-time notification […]
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Newly Revised CPT E&M Guidelines: Physician Fee Schedule Proposed Rule

Newly Revised CPT E&M Guidelines: Physician Fee Schedule Proposed Rule

A major revision of the Current Procedural Terminology (CPT) Evaluation and Management (E&M) Guidelines for Office and Outpatient Visits (O/O Visits), Split/Shared Visits, and Critical Care Time billing was implemented Jan. 1, 2021. You would think that all office-based providers would have been made aware of this and changed their documentation accordingly, but there is […]
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Clinical Coding Changes: ICD-10-CM/PCS C&M Committee

Clinical Coding Changes: ICD-10-CM/PCS C&M Committee

Throughout the years in the health information management field, we’ve always been deeply interested in clinical coding and even find clinical coding to be fun. With that comes learning about the annual coding changes: new, revised and deleted codes. That brings us to the ICD-10-CM/PCS Coordination and Maintenance (C&M) Committee, how they work and the […]
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Coding Drives Up Medical Billing Costs in US

Coding Drives Up Medical Billing Costs in US

Another study confirms that medical billing costs in the US significantly exceed those in similar countries, but researchers now know why: coding drives up US administrative spending. Complex coding structures in the US are driving up medical billing costs in the US, making it one of the most expensive countries to get paid, according to […]
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CMS Announces New Appeal Rights

CMS Announces New Appeal Rights

Appeal rights appear much narrower than many expected. Earlier this year, a federal appeals court issued an opinion on Barrows v. Becerra, a long-running class action lawsuit. Filed by a group of Medicare beneficiaries, the suit alleged they had to pay out of pocket for skilled nursing care—despite being hospitalized for over three days—because their […]
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