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Medical billing is entering a new era. Claims are no longer being evaluated only through traditional payer edits and manual reviews. Artificial intelligence, machine learning, increased Medicare Advantage participation, tighter documentation requirements, and specialty-specific reimbursement rules are changing how healthcare...

Healthcare organizations increasingly depend on third-party medical billing and revenue cycle management (RCM) companies to process claims, manage accounts receivable, communicate with payers, and handle large volumes of sensitive patient information. A recently disclosed cybersecurity incident involving medical billing and...

Could the Foundation of U.S. Procedure Coding Eventually Change? For decades, Current Procedural Terminology (CPT®) has been at the center of physician and outpatient procedure coding in the United States. Medical coders learn it. Providers document services that are reported...