Medical Coding

From Pilot to Scale, Mount Sinai Leverages Autonomous Medical Coding

February 12, 2024 - An experiment to streamline medical coding is set to take off at Mount Sinai Health System. The academic medical system nestled in the New York metropolitan area recently implemented autonomous medical coding within its pathology department to streamline coding and bring efficiencies to care delivery. Now, the technology codes about half of the system’s pathology cases, with...


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How AI is Becoming a Staple in Medical Coding, Auditing

by Jacqueline LaPointe

Troves of data flow through the healthcare revenue cycle. Yet, many providers struggle to make sense of the codes and clinical documentation to not only submit clean claims but also understand patient encounters that occur within their...

Revenue Cycle Sets Sights on Autonomous Coding, Claims Automation

by Jacqueline LaPointe

Revenue cycle leaders at top healthcare organizations are prioritizing automation, with autonomous coding and claims management at the top of their wish lists, a new KLAS report reveals. KLAS surveyed...

How Do Healthcare Organizations Feel About Autonomous Coding?

by Victoria Bailey

Autonomous coding can help streamline revenue cycle processes and reduce administrative burden, but over half of surveyed healthcare finance leaders are not familiar with it, while others do not fully...

AMA 2024 CPT Code Set Addresses Language Barriers, Immunization Codes

by Victoria Bailey

The American Medical Association (AMA) has released the 2024 Current Procedural Terminology (CPT) code set, which addresses language barriers by including Spanish descriptors of medical services. Each...

What Payment Integrity Means for Providers, How to Avoid Claim Issues

by Jacqueline LaPointe

Healthcare providers are constantly running into payment integrity tools payers put in place to ensure proper payment. But payment integrity is also crucial for providers if they want accurate, complete, and timely reimbursement. Of the...

KLAS Report Shares Top Outsourcing Firms for Healthcare Coding Services

by Victoria Bailey

As healthcare organizations turn to outsourcing firms for coding services, they value vendors that excel in communication, coding quality, and staff retention, according to a KLAS report. Outsourcing...

OIG: Medicare Overpayments Due to Coding Discrepancies Totaled $22.5M

by Victoria Bailey

Medicare improperly paid practitioners at a higher non-facility rate for services provided to skilled nursing facility (SNF) or hospital inpatients, leading to over $22 million in overpayments, a...

KLAS Shares User Reviews of Computer-Assisted Coding Vendors

by Victoria Bailey

Healthcare organizations value client support, coder productivity, and accuracy when selecting computer-assisted coding (CAC) vendors, a KLAS report found. The Computer-Assisted Coding 2023 report...

Provider Groups Band Together to End Cigna’s Modifier 25 Policy

by Jacqueline LaPointe

The American Medical Association (AMA) and more than 100 other provider trade associations have taken issue with a new policy from The Cigna Group regarding claims with modifier 25. Cigna recently...

AMGA Opposes Proposed Medicare Advantage Coding Changes

by Victoria Bailey

AMGA has asked CMS not to finalize the coding changes included in the 2024 Medicare Advantage Advance Notice that would revise diagnoses and condition categories in the hierarchical condition...

How E/M Payment Policy Changes Impacted Physician Reimbursement

by Victoria Bailey

Evaluation and management (E/M) payment policy changes implemented in 2021 resulted in higher Medicare reimbursement for most physicians but only led to a modest decrease in the payment gap between...

Providers are Increasingly Billing Outpatient Visits at Higher Levels

by Victoria Bailey

Outpatient visits are being billed at higher levels, leading to increased healthcare spending and concerns about upcoding, a Peterson-KFF Health System Tracker found. Healthcare providers can bill...

Providers, Payers In Ongoing “Tug-of-War” Over ED Coding, Study Says

by Jacqueline LaPointe

There has been a significant increase in high-intensity billing for emergency care services over the last decade, according to a new study published in Health Affairs. The observational study of US...

Medical Coding is the Next Stop for Artificial Intelligence in Healthcare

by Jacqueline LaPointe

To a layperson, medical codes look like a different language, and in a way they are. Medical coding is a highly complex process in healthcare in which clinicians and revenue cycle staff work together to translate clinical encounters into...

3 Trends from the Revenue Cycle Management Virtual Summit

by Jacqueline LaPointe

Patient financial experience, denial prevention, and remote work are major challenges for healthcare organizations, according to healthcare leaders at this year’s Revenue Cycle Management Virtual Summit. The Summit took place on...

AMA Releases 2023 CPT Code Set, Aims to Reduce E/M Coding Burden

by Jacqueline LaPointe

The American Medical Association (AMA) has released the Current Procedural Terminology (CPT) code set for 2023, which contains updates that aim to reduce medical coding burden for evaluation and...

8 New CPT Codes Added for Bivalent COVID-19 Booster Doses

by Jacqueline LaPointe

The American Medical Association (AMA) has announced an editorial update to its Current Procedural Terminology (CPT) code set to include eight new codes for the bivalent COVID-19 vaccine doses from...

Coding Drives Up Medical Billing Costs in the US

by Jacqueline LaPointe

Complex coding structures in the US are driving up medical billing costs in the US, making it one of the most expensive countries to get paid, according to a new study. The study published in Health...