How CMS WISeR Is Using AI to Review Prior Authorization and Claims
I have been in revenue cycle management for over 18 years. And honestly it’s the first time Medicare has considered AI to review prior authorization, claims, and coding. But how they are doing it? Through WISeR which stands for Wasteful and Inappropriate Service Reduction. It was launched on January 1, 2026. It is not a […]
2026 Guide to AI in Medical Coding for Healthcare Providers
AI in medical coding hit production scale in 2025. Health systems are processing thousands of charts weekly without human coders touching them. Physicians are seeing codes assigned in real-time during patient encounters. Revenue cycle teams are watching denial rates drop while coding backlogs disappear. If you’re a healthcare provider or administrator, 2026 brings regulatory changes […]
Everything About AI in Medical Billing for 2026
AI in medical billing is here, and 2026 marks the year when it becomes mandatory for most providers. The Centers for Medicare and Medicaid Services is rolling out new regulations that will fundamentally change how billing works, from AI-powered prior authorizations to strict electronic submission deadlines. The conversation around AI medical billing has also shifted. […]
70% of Health Systems Are Adopting AI Medical Coding This Year, Here’s Why
I’ve spent nearly two decades in revenue cycle management, overseeing operations that process millions of claims annually. Most of that time, I’ve watched vendors pitch “revolutionary” technology that turned out to be minor upgrades with better marketing. But what I’m seeing with AI in medical coding is different. It’s fundamentally changing the economics of how […]
Common DME Billing Errors Every Provider Needs to Know
Durable Medical Equipment (DME) billing is one of the most error‑prone areas in healthcare reimbursement. Small mistakes in billing details can result in DME claim denials, delayed reimbursement, and increased administrative costs. According to industry reports, common issues such as incorrect patient information, coding errors, and missing documentation are major contributors to claim rejections. With […]
Documentation Requirements for Neurosurgery CPT Codes
Neurosurgery practices face nearly double the 5-10% average across other medical specialties, with an 18% claim denial rate. The primary reason isn’t incorrect Neurosurgery CPT codes or lack of medical necessity, but inadequate documentation. When operative reports miss critical details about procedures performed, or when medical records fail to justify why surgery was necessary, insurance […]
Understanding DME HCPCS Codes: The Key to Accurate Medical Equipment Billing
When you hear the term DME HCPCS Codes, it refers to a standardized set of codes used to describe durable medical equipment (DME), supplies, and non‑physician services for billing and insurance claims. The acronym HCPCS stands for Centers for Medicare & Medicaid Services (CMS)’ Healthcare Common Procedure Coding System. The “DME” part indicates that these […]
Pediatric CPT Codes Breakdown by Age Groups
Age-specific errors in pediatric CPT codes cost practices thousands monthly, yet they’re completely preventable once you know the exact cutoffs. Bill a five-year-old’s checkup with an infant code, and watch your claim get rejected within 48 hours. Use 99382 instead of 99383 for that same visit, and you’ve just underbilled by $30. Pediatric billing and […]
What Providers Need to Know About the QZ Modifier?
The use of the QZ modifier by Certified Registered Nurse Anesthetists (CRNAs) has grown significantly in recent years. Between 2000 and 2014, the percentage of anesthesia claims under Medicare using the modifier QZ increased from 10.9% to 21.7%. This shift reflects changes in how anesthesia services are delivered and billed, with anesthesia services accounting for […]
A Complete Physician Guide to Professional vs Institutional Claims
Across the U.S., physicians lose revenue every year because claims are sent with the wrong type, wrong form, or missing details. Much of this starts with confusion about professional vs institutional claims. When professional claims and institutional claims are mixed up, payers deny or delay payment. This guide explains institutional vs professional claims step by […]