Docs warn that Medicare payment rates put them in a precarious financial situation

Published: Mon, 09/15/25

Updated: Mon, 09/15/25

Link to all things medical coding & billing

Docs warn that Medicare payment rates put them in a precarious financial situation

Physicians are asking for greater certainty around Medicare reimbursement, arguing that compounding payment decreases over time have drastically increased the pressure on practices. Industry organizations, individual physicians and others weighed in through comments on the proposed Physician Fee Schedule, which were due Friday...

Update on PEPPER, Discharge Planning Guidelines, and Coding AMA Discharges

Let’s start with some updates. We have all been Program for Evaluating Payment Patterns Electronic Report (PEPPER)-free for quite a while now, but I can report that there is finally new information. First, there is a new contractor, Index Analytics, LLC. They appear to do a lot of data work with the federal government, so we will see how they do with...

Looking Forward to 2026: What CDI Leadership Needs to Know

The biggest impacts to clinical documentation integrity (CDI) professionals for the 2026 fiscal year (FY) will not be associated with updates to the ICD-10-CM code set or the Inpatient Prospective Payment System (IPPS). The biggest impacts will have to do with impending policy changes to Medicare and Medicaid. In my last article, I...

Your first AI win might be the one you don’t see

If you’re waiting for the perfect moment to bring AI into your business, here’s a thought: What if your first win isn’t flashy—it’s just functional? Let me show you what I mean, right here in Baton Rouge. At Baton Rouge General Medical Center, doctors and nurses are using AI to improve patient care—not by replacing anyone, but by supporting clinicians behind the...

Why this summer is make-or-break for star ratings

While plans are still grappling with last year’s significant changes to The Center for Medicare and Medicaid Services (CMS) 2025 Star Ratings, more change is on the way. The new administration and Dr. Mehmet Oz, as leader of the CMS, have pledged stricter scrutiny of insurers and have indicated that more measures are on the horizon. For Medicare...

Wound Care: Medicare Audits & The Skin Substitute Surge

Federal contractors – Recovery Audit Contractors (RACs) and Unified Program Integrity Contractors (UPICs) – have increasingly targeted wound care claims, particularly involving expensive skin substitutes billed under Medicare Part B. In 2023 alone, over $1.6 billion was spent on these products, prompting heightened audit activity from Qlarant...

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