MedLearn Publishing

Biliary drainage complexities will not cease in 2026, and with reimbursement and resources tightening because of final rules and economic turmoil, now is a critical time to review coding for an accurate understanding. Learning when to report biliary drainage, biopsy, cholangiography, catheter conversions, and stent placement requires careful review of procedural documentation...

The Centers for Medicare & Medicaid Services (CMS) proposed a rule intended to reduce what it describes as excessive state payment practices, and to redirect funding toward direct patient care. CMS estimates that the proposal could save hundreds of billions of dollars over the next decade.

Supporters say it addresses waste and abuse; critics worry it could reduc...

Every once in a while, a regulatory news story inspires me to bestow upon readers a little bit of medical information. And this time it was an advisory opinion from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG).

The Centers for Medicare & Medicaid Services (CMS) has finally released its long-awaited No Surprises Act (NSA) Independent Dispute Resolution (IDR) Final Rule, introducing a series of changes that are meant to reshape how payers and providers navigate the NSA arbitration process – but does it actually address the underlying issues with the process? Not according to some....

What’s happening in healthcare today regarding artificial intelligence (AI) and auditing?

What I am seeing across the auditing landscape is the expectation that AI will become a primary auditing method and tool in the future.

With AI, we can expect less manual data entry, the ability to audit more claims or larger statistically valid samples, and more robu...