The 2026 CPT® code set brings 418 changes, including hundreds of new, revised, and deleted codes impacting billing, compliance, and reimbursement. Medical coders, billers, and healthcare providers ...

Medical coders often walk a fine line between meeting employer demands and upholding ethical standards. When pressured to miscode for higher reimbursement, the stakes include legal risk, professional ...

Blue Cross Blue Shield of Massachusetts is expanding its claims review process to address what it is describing as potential overcoding among physicians who routinely bill for high-complexity visits.

Suki, an ambient AI healthcare company, is expanding its assisted revenue cycle capabilities to provide more specific automation and generate additional codes, including CPT and E/M codes. Suki, which ...

Here are five notable developments from Cigna over the last month: 1. The Cigna Group has named Eva Borden as chief product officer for its commercial insurance business. Ms. Borden, who joined Cigna ...

In the U.S. healthcare industry, claim denials are a significant issue, costing healthcare providers billions of dollars every year. it’s estimated that denied claims amount to astounding $250 billion ...

Aetna recently announced that effective September 1, 2025, its Claim and Code Review Program (CCRP) will expand to include additional claim coding edits for all commercial, Medicare, and Student ...

Although Recovery Audit Contractors (RACs) are not currently evaluating facility evaluation and management (E&M) services, it may not be long before they do. In the 2010 final rule for the hospital ...

The practice of medicine, as a business, is a challenging model. You have minimal control over your prices, no ability to negotiate with your biggest payers (the governmental ones, that is), and ...