Over the past 20 years, Healthcare has seen an increased interest in the impact and influence of “Social Determinants of Health” or SDOH. Recent the Centers for Medicare and Medicaid Services (CMS). Health plans themselves have become more interested in SDOH and the associated cost of care present and future. Now we have CMS Medicare Part C raised attention to SDOH also. 

The CPT coding system was introduced in 1966, and was originally intended to simplify documenting procedures that physicians performed. By 1970, the system had changed to include lab procedures, and the codes had expanded to five digits. The concept of modifiers was introduced in the third edition of CPT in 1973. Modifiers provide additional information about a procedure...

We don’t live in a bubble. We are a globalized economy. Until artificial intelligence has total capability in healthcare, the human touch is what sets us apart from just carrying out a set of functions efficiently. Since the COVID-19 pandemic landed, it has had an unprecedented impact on most countries, and an already taxed U.S. health system regarding mental health and...

The Office of Inspector General released in January 2022 an audit report on Medical Advantage for Healthfirst Health Plan, Inc. The identified errors were related to some specific diagnosis codes and Hierarchical Condition Categories (HCCs). Another Medicare Advantage Audit Report from the OIG! This particular audit report by the Health and Human Services (HHS) Office of...

Cancer screening saves lives and reduces the burden of cancer in the United States. However, gaps in screening programs mean far too many in the US are presenting with late-stage disease or dying from cancers that were preventable or could have been detected at an earlier stage. The socially and economically disadvantaged populations are often at higher risk for cancer...

Just about anyone who’s taken medical terminology recognizes the term “eponym”. The Merriam Webster dictionary, along with the Wikipedia website have the same definition for the word “eponym”. Roughly paraphrased, an eponym puts the name on a place, thing, discovery, or invention of the person who is believed/thought to have “discovered” it. Being awarded an eponym in...

Finding purpose through meaningful work has been on the minds of many lately. Purpose, essential to organizational development and the lifeblood of the human heart as it relates to the whole organizational body system, is what makes life meaningful. Often, health care workers enter the health care field because they love to help people and contribute to enhancing a...

Melanoma is a type of skin cancer that arises in the melanocytes or cells that produce melanin and determines the color of your skin, or pigment. Melanoma can form in the eyes, and on rare occasions inside the body such as the nose or throat. Its exact causes are not always clear, but evidence does support exposure to ultraviolet (UV) radiation from sunlight or tanning...

The Office of Inspector General (OIG) “Work Plan” is a roadmap to many compliance focused areas across healthcare. In addition, the Work Plan can serve as an audit plan for many healthcare settings identifying where compliance risks of overpayments are from federally funded programs. With the focus on specific Health and Human Services (HHS) programs, the OIG Work Plan is...

In 2021, CMS released the fiscal year 2022 code descriptions, tables, index and addendum which went into effect October 1st. The updates included 32 deleted codes, 20 revised codes, and 159 new codes. Although key changes will be highlighted in this article, be sure to review both the guidelines and code updates in their entirety to ensure proper coding and reporting. ...