medical coding

2025 MPFS final rule contains 2.93% reduction to overall payments

By ACDIS for CDI Strategies The 2025 Medicare Physician Fee Schedule (MPFS) final rule was released on November 1 and contains a number of billing modifications to payment rates, services, telehealth rules, and other such services. According to the National Association of Healthcare Revenue Integrity (NAHRI), CMS finalized a 2.83% reduction to the conversion factor.…

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CMS Introduces New Appeals Process for Medicare Beneficiaries Reclassified from Inpatient to Outpatient

By Tiffany Ferguson, LMSW, CMAC, ACM for RACmonitor On Oct. 11, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS 4204-F) establishing a new appeals process for Medicare beneficiaries who are initially admitted to a hospital as inpatients, but later reclassified as outpatients receiving observation services. This rule is the result…

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FY 2025 IPPS rates changed last minute due to court decision

From ACDIS CDI Strategies To comply with a summer court order, the fiscal year (FY) 2025 Hospital Inpatient Prospective Payment System (IPPS) was revised a day before its implementation on October 1 to reduce payments for low wage hospitals, JustCoding reported. The update was primarily focused on the low wage index hospital policy, which since…

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What’s keeping medical coders up at night?

By Andrew Cass for Becker’s Hospital CFO Report Regulatory challenges, evolving coding practices and ethical concerns are the critical issues facing medical coders, according to an Oct. 18 report from Black Book Research.  Here are five things to know from Black Book’s survey of health information management professionals:  1. Ninety percent of those surveyed said…

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The unexpected consequences of hospital quality scores

By Alice Brewer for HealthcareDive One clinical affairs expert argues that it’s time to reexamine the federal Hospital-Acquired Condition Reduction Program. The latest list of hospitals facing federal penalties for poor quality has been released. Through hospital quality scores, the CMS evaluates hospitals on infection rates and other patient complications, reducing their Medicare payment rates…

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How UC Davis Health Is Bolstering Neurodivergent Talent With Pilot Program

By Jasmyne Ray for HealthLeaders The program offers a career path for neurodivergent individuals, enabling them to be more independent. KEY TAKEAWAYS Medical coders are an integral part of revenue cycle operations. But with the ongoing workforce shortage and the level of expertise needed for the role, the talent pool of qualified candidates is small.…

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CMS floats 2.6% hospital outpatient pay increase for 2025: 7 things to know

By Alan Condon for Becker’s Hospital Review CMS has published its Outpatient Prospective Payment System proposed rule for 2025, which, among other things, would raise Medicare outpatient payment rates for about 3,500 hospitals and 6,100 ASCs next year.  Seven things to know: 1. CMS has proposed a 2.6% outpatient pay increase for hospitals in 2025.…

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