AI tools include anomaly detection, predictive analysis, and social network analysis. Medicare fraud is a serious issue and an expensive one. “Improper payments” amount to more than $52 billion per year.

We were discussing opioid dependence in my CDI education session last week and it spurred me to write this article. Each week we review a topic often elicited by a real-life case. Opioid misuse and addiction is a public health crisis...

The Centers for Medicare & Medicaid Services (CMS) is moving quickly on its strategies for outpatient office evaluation and management (E&M) services, targeted for implementation in 2021, and the American Medical Association (AMA) is working hard to try and keep up.

The revision was long pending and will feed the country-level mortality and morbidity data requirements to progress towards achieving sustainable development goals (SDGs) and universal health coverage (UHC).

It seems that every day there are articles or legislation in the state and federal government intended to put a stop to so-called “surprise bills.” Fingers are pointed, blame is placed, and causes are cited to support particular positions. 

The ICD-10-CM is so granular that it has been described as needlessly specific, absurd, and unnecessarily detailed. Some argue that this seemingly excessive detail, in theory, allows for more accurate labeling of diagnoses required both for billing and observational analysis.

The Centers for Medicare & Medicaid Services (CMS) recently made significant changes in its statistical sampling methodology for overpayment estimation. Effective Jan. 2, 2019, CMS radically changed its guidance on the use of extrapolation in audits by...