As ICD-10 denial trends continue to reveal insights into documentation trends, payer expectations, and compliance challenges as the healthcare industry moves deeper into 2025. The first quarter of the year (Q1 2025) brought a mix of the expected and the surprising in terms of ICD-10-CM diagnosis code denials. This newsletter provides an in-depth analysis of […]
Is your outpatient medical billing process feeling more like a tangled web than a well-oiled machine? You’re not alone. In the fast-paced world of healthcare, billing errors and inefficiencies can easily creep in, leading to delayed payments, increased denials, and a significant drain on your practice’s resources. The good news? You don’t have to overhaul […]
Claim denials cast a long shadow over hospital finances, eroding revenue cycles, inflating administrative burdens, and ultimately jeopardizing the institution’s financial stability. While some denials are unavoidable, a powerful and forward-thinking Hospital Claim Validation strategy can dramatically reduce their frequency. This approach emphasizes embedding accuracy and compliance at every touchpoint of the patient journey and […]
Using surgery modifiers to accurately represent the role of assistant surgeons has become increasingly important over the past three decades. Initially, a simple mention of the assistant surgeon’s name in the operative note header sufficed. However, as the healthcare landscape evolved, payers began demanding more granular details about the assistant surgeon’s role and contributions to […]
The clinical documentation improvement (CDI) vendor landscape has undergone significant changes over the last couple of years, including vendor acquisitions and technology developments. And these changes and other factors have had an impact on customer experience, according to a recent KLAS report. For example, vendors like Iodine, Optum, and 3M have gained momentum over the past […]
One billion dollars is a big number, but more astounding to me, as it pertains to a recent finding by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), was that hospitals were found to have incorrectly documented and/or coded severe malnutrition 86.5 percent of the time (173/200)! That’s […]
Case study proves the need for physicians to be members of the CDI team. Having a strong denials management team is critical for facilities. If providers do not leverage proper resources to generate strong appeal letters, the third-party payers will uphold their decisions to remove or change diagnosis or procedure codes. This usually will lead […]
88% of providers are eager to implement clinical document improvement technology that leverages AI, and 93% believe the systems can streamline document creation. Forty-four percent of healthcare organizations already use artificial intelligence (AI) in one form or another, and more hospitals are looking to apply the technology to coding and clinical documentation improvement, a recent […]
Chronic Kidney Disease (CKD) is a serious health condition affecting millions of people worldwide. In the United States alone, 15% of adults, or approximately 37 million people, suffer from CKD. This condition, often insidious in its onset, can lead to severe complications and significantly impact quality of life. Key Facts about CKD: Prevalence: More common […]