Medical Payers & Insurance Companies

articles, webinars, tips, links, forms, files and other resources related to coding, reimbursement and compliance for medical payers and insurance companies


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AetnaBC|BSCMS|MedicareMedicaidUnitedHealthcare


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recent articles

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2025-07-10-MLNC

by  CMS - MLNConnects

Medicare Improperly Paid Suppliers for Intermittent Urinary Catheters - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation...

Surgeon Payments in the Crosshairs Following HHS OIG Audit

by  Ronald Hirsch, MD FACP CHCQM CHRI

Today, in utilization news, there is a warning to any surgeons who may be reading this – or anyone who works with surgeons. You may see new efforts by the Centers for Medicare & Medicaid Services (CMS) to lower your fees in coming years. We have all heard about...

2025-06-26-MLNC

by  CMS - MLNConnects

Commodes, Bed Pans & Urinals: Prevent Claim Denials Claims, Pricers & Codes Integrated Outpatient Code Editor Version 26.2 - Medical Education: Don’t Submit Claims for Programs of All-Inclusive Care for the Elderly - MLN Matters® Articles DMEPOS Fee Schedule: July 2025 Quarterly Update Publications...

2025-07-03-MLNC

by  CMS - MLNConnects

CMS Screening, Brief Intervention & Referral to Treatment (SBIRT) Services — Revised; CMS Notifies Individuals Potentially Impacted by Data Incident; CMS Launches New Model to Target Wasteful, Inappropriate Services in Original Medicare

MLNConnects - 2025-06-12

by  CMS - MLNConnects

Mechanical Ventilation: Bill Correctly for Inpatient Claims - SNF Services: Prevent Claim Denials MLN Matters® Articles - Ambulatory Surgical Center...

Measles Coding Considerations

by  Christine Geiger, MA, RHIA, CCS, CRC

Considering the increase in measles cases in the United States and globally, it is a great time to review how we code for this condition. According to Centers for Disease Control and Prevention (CDC) data, updated on May 30, so far this year we have had 1,088 domestic measles...

Medical Coding Haemophilus Influenzae

by  Janine Mothershed

Here's a clear and thorough guide for medical coding and billing for Haemophilus influenzae (H. influenzae) — not to be confused with the flu (influenza virus). This bacterium can cause serious invasive diseases like meningitis, epiglottitis, pneumonia, and sepsis. Common ICD-10 Diagnosis Codes: - A41.3...

What Coders Need to Know: Anticoagulant versus Antiplatelet – Coding Considerations

by  Christine Geiger, MA, RHIA, CCS, CRC

Continuing our look at areas where we see confusion we will examine the assignment of the long term use codes for anticoagulants versus antithrombotics/antiplatelets.  GoodRx.com, in an article titled, “Antiplatelet vs. Anticoagulant Blood Thinners – 4 Things to Know,” details the basics coders need to keep in mind when...

MLN Connects Newsletter

by  CMS - MLNConnects

Walkers: Prevent Claim Denials - Medicare Preventive Services — Revised

Dental Claims Requiring Use of ICD-10-CM Codes

by  Christine Taxin, President - Links2Success

Dental claims now require the use of ICD-10-CM codes. Several states (e.g., Arizona) have begun to mandate that diagnosis codes be reported along with dental codes on claim forms.
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