The new Patient-Driven Payment Model, or PDPM, makes radical changes to the Medicare payment model for nursing homes. One of the largest changes is the reimbursement rate for services provided to HIV and AIDS patients.

Care coordination and planning are becoming increasingly important to caring for the millions of Medicare beneficiaries suffering from two or more serious health conditions, such as diabetes and heart disease. But many providers believe that current Medicare billing codes do not reflect the resources needed to provide such care.

When your job is converting medical documentation into codes, your knowledge of medical anatomy has to be shipshape. But you’ve got the added complication that the code set you’re using may have its own definitions for specific terms. Case in point: CPT^® guidelines set out five major coronary arteries with coronary artery branches...

Recently got an opportunity to interact with a few life sciences students. That is when I asked a student who seemed keen about getting into the pharma industry: “What if you don’t get your desired job profile”? This question actually was a bolt from the blue as he was baffled and realized he didn’t have a plan B.

Prior authorizations consume hours of physician time as they seek insurer approval for drugs and treatments. Health plans say prior auths improve the quality of care and manage healthcare spending, but doctors say they infringe on their autonomy and take time away from patients.

CMS has provided ICD-10 Procedure Coding System updates for the fiscal year beginning Oct. 1, 2019, and ending Sept. 30, 2020. Four takeaways...

The case continues even after two suicides. When does an audit go beyond the reasonable and become persecution? An act of tyranny by claim denial and extrapolation? Vernon Partners LLC (name changed for reasons of confidentiality), a medical...

There are 2,115 additions to the third quarter Medicare National Correct Coding Initiative (NCCI or CCI) practitioner edits that became effective July 1, 2019. The good news is that the bulk of the new edits affect a comparatively small number of highly specialized HCPCS codes. Around three-quarters of the additions, 1,604...