Inpatient encounters for Medicare patients 65 years and older are associated with higher coding intensity compared with commercially insured, Medicaid, or self-pay hospitalizations for those same ...

Incorrect diagnosis codes from providers led to a $14 million windfall for some Medicare Advantage plans, a federal watchdog found. The Department of Health and Human Services’ Office of Inspector ...

Ambience Healthcare rolled out an ICD-10 clinical document integrity assistant for inpatient care, aiming to help hospitalists document more accurate clinical notes and reduce billing and coding ...

Inpatient hospital stays have become more expensive to the Medicare program. It's a trend that began even before the COVID-19 pandemic. A new report from the Department of Health and Human Services' ...

As we reported in our Managed Care Newsletter in April 2020, the CARES Act passed by Congress last year provides for a 20% increase to the DRG weights in the Medicare Inpatient Prospective Payment ...

Diagnosis-based payment systems can create incentives to upcode patients to a higher level of severity to increase payment. In some instances, upcoding can be a form of fraud if providers code ...

RAAPID INC launched a unified Risk Adjustment Platform designed to integrate clinical documentation, coding, quality assurance, audit management, and evidence trails into a single system intended to ...

As of January 1, 2026, the medical coding landscape has undergone its most significant transformation in years, with the AMA releasing 418 CPT changes and CMS finalizing updated ICD-10-CM guidelines ...