This week’s Medicare updates include the 2027 ESRD PPS final rule, a final decision memo regarding coverage of autologous stem cell transplantation, and more!
Laboratory services are often overlooked as potential suspects for fraud because they are typically not considered high-cost services. But the sheer volume of laboratory services billed more than compensates for their low cost. These charges represent hundreds of millions in healthcare spending.
HIM departments are increasingly being drawn into revenue recovery decisions while also being asked to help ensure coding and documentation workflows remain accurate, traceable, and defensible.
As coding teams collaborate across regions and contribute to shared quality and artificial intelligence (AI) evaluation initiatives, a common framework for measuring coding quality becomes essential.
Outpatient clinical documentation improvement plays a critical role in establishing medical necessity, supporting accurate coding and reimbursement, and reducing claim denials.
