The Compliance Clinic examines key Medicare, Medicaid, and government enforcement developments across the healthcare industry. Each edition focuses ...
The proposed new Medicare billing codes in the proposed Physician Fee Schedule (PFS) for 2025 include three specific codes for digital mental health treatment (DMHT) relating to professional services ...
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Mastering Medicare billing changes for 2026
Medicare’s 2026 updates are reshaping billing rules, CPT code valuations, and reimbursement structures, pushing clinics and ...
Responding to criticisms lodged against an otherwise popular program among seniors, Senators Bill Cassidy, M.D. (R-LA) and Jeff Merkley (D-OR) introduced a bill to improve the way Medicare Advantage ...
The Centers for Medicare and Medicaid Services updated its policy for coding place of service, according to AAPC. The changes stipulate services for registered outpatients should be reported with POS ...
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Medical Coding in 2026 Undergoes Major Shifts in CPT Additions and ICD-10 Structural Rules
In 2026, medical coding saw two defining changes: the addition of 288 CPT/HCPCS codes that formalize billing for emerging AI and digital health services, and an April ICD-10-CM update that overhauled ...
CMS has released its final rule for Medicare Advantage and Part D for 2026, introducing several regulatory changes aimed at improving care coordination and beneficiary protections. While the rule ...
The Biden administration has finalized a rule targeting fraudulent billing in Medicare’s largest value-based care program, after concerning reports of spiking spending on urinary catheters. The ...
There is widespread agreement that taxpayers pay more when Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans than if those beneficiaries were enrolled in traditional Medicare. MA ...
Inpatient encounters for Medicare patients 65 years and older are associated with higher coding intensity compared with commercially insured, Medicaid, or self-pay hospitalizations for those same ...
The healthcare industry is no stranger to technological advancements, and artificial intelligence (AI) is quickly becoming a game-changer in multiple areas. From diagnosing medical conditions to ...
Over the last few years, there has been an uptick in Medicare billing privileges deactivations for failure to timely and fully update or revalidate Medicare enrollment information and respond to ...
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