When Two CMS Factions Interpret Identical Facts Differently

Published: Mon, 09/29/25

Updated: Mon, 09/29/25

Link to all things medical coding & billing

When Two CMS Factions Interpret Identical Facts Differently

There are times when the Centers for Medicare & Medicaid Services (CMS) doesn’t agree with itself. I am dealing with a situation in which one team at CMS is saying the No Surprises Act (NSA) applies, and another is saying it doesn’t. One of my clients in Florida received an inquiry from CMS. Like many Sun Belt facilities, this organization frequently gets...

Revenue Cycle at a Crossroads: AI is Not Enough

America’s healthcare system is heading toward a breaking point. By 2030 the US will face a shortage of more than 86,000 physicians. Hospital margins are razor thin, especially in rural communities, and federal plans call for more than one trillion dollars in Medicaid cuts over the coming decade. In this environment, hospital leaders are racing to adopt...

Coders on Borrowed Time

For decades, armies of medical coders have served as the translators of American healthcare, converting physician notes and hospital encounters into ICD, CPT®, and HCPCS codes that power reimbursement, compliance, and analytics. But as artificial intelligence (AI) becomes more capable, faster, and cheaper, the writing on the wall is clear: medical...

Coding Considerations When Waiting for Transfer

Today’s topic is in reference to a coder question posed about discharge status for inpatients who are waiting for discharge to a nursing home. The questioner noted the possibility of discharging to outpatient status while waiting for nursing home placement. The information request also noted not being able to find any rules that apply to this...

AMA releases CPT 2026 code set

The American Medical Association (AMA) announced the release of the Current Procedural Terminology (CPT^®) 2026 code set adding 288 new codes designating the latest advances in medical, surgical, and diagnostic services available to patients. The CPT code set is trusted as the backbone of health data interoperability in the U.S.

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...

P.O. Box 3824
Youngstown OH 44513
USA

Unsubscribe | Change Subscriber Options