Category: Newsletters

ICD-10-CM Code Updates

ICD-10-CM FY 2027 Code Updates

The Centers for Medicare and Medicaid Services (CMS) has unveiled the Fiscal Year 2027 ICD-10-CM update, introducing a sweeping set of changes that will significantly affect physician practices and medical coders throughout the United States. This update, featuring 238 new diagnosis codes, several important revisions, and select code deletions, becomes effective for patient encounters on […]
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Trends in healthcare spending

Trends in healthcare spending

In 2024, the landscape of healthcare spending in the United States underwent another significant shift, continuing a trend seen in recent years. Total health expenditures in the country rose by 7.2%, bringing the annual total to an astonishing 5.3trillion∗∗, which equates to about∗∗5.3 trillion**, which equates to about **15,474 per capita. This impressive growth rate […]
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No Surprises Act IDR Rule

No Surprises Act IDR rule 2026 with MGMA’s

Federal regulators have completed a long-anticipated update to the No Surprises Act’s Independent Dispute Resolution (IDR) process. The most significant change is the administrative fee to initiate a dispute, which has dropped from $115 to $15 per party. The updated rule, finalized in late May, also requires health insurers to use standardized claim adjustment codes. […]
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Status Integrity in Hospitals

Status Integrity in Hospitals: What CDI and UR Teams Need to Know

Hospitals have spent years addressing medical necessity denials after claims are submitted. Traditionally, this has involved writing appeals, completing peer-to-peer reviews, discussing payer trends, and reviewing denial dashboards. However, the next level of denial prevention will not be achieved through the appeal process alone. Instead, it must start much earlier—at the point where patient status, […]
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Revenue Leaks in Medical Practices

8 Practical Ways to Plug Revenue Leaks in Medical Billing

In today’s healthcare landscape, ensuring every dollar earned is actually collected is more important than ever. Rising patient deductibles, increasingly stringent payer requirements, and persistent staffing shortages all threaten the financial stability of medical practices. While these challenges may seem out of your control, many of the most common sources of lost revenue, often referred […]
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No Surprises Act Enforcement

Healthcare Providers Push for Stronger Enforcement of the No Surprises Act

The American Medical Association (AMA) and nearly 100 other organizations are backing legislation that aims to force payers to comply with independent dispute resolution (IDR) payment determination rules. This unified action comes amid ongoing reports from providers about nonpayment, delayed payment, and improper billing practices by payers. Healthcare providers are now asking lawmakers to put […]
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Renewing Payer Contracts

8 questions to ask before renewing a payer contract

In the complex world of healthcare, practice revenue can quietly erode over time due to hidden pitfalls in payer contracts. Auto-renewal clauses, outdated fee schedules, and overlooked contract terms can all conspire to reduce your bottom line without you even noticing. As contract renewal windows approach, it’s essential to be proactive rather than reactive. To […]
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