https://duringhealth.com/insights/ Perspectives on agentic AI, health data, revenue cycle, compliance and digital health. en-us Tue, 13 Oct 2026 00:00:00 GMT https://duringhealth.com/insights/icd-11-us-health-organizations-what-to-know/ https://duringhealth.com/insights/icd-11-us-health-organizations-what-to-know/ Tue, 13 Oct 2026 00:00:00 GMT Medical Coding & HIM Much of the world is already working with ICD-11. US claims still run on ICD-10-CM, and no date is set. What is different, what is unresolved, and the preparation that pays off whichever way it goes. https://duringhealth.com/insights/ai-coding-tools-case-complexity-bcbsa-analysis/ https://duringhealth.com/insights/ai-coding-tools-case-complexity-bcbsa-analysis/ Fri, 09 Oct 2026 00:00:00 GMT Audit, Compliance & Risk Insurers say hospital AI coding added about $942 million in costs. Hospitals say the claims data cannot prove it. Both can be partly right, and both point to the same homework for any organization that uses AI in coding. https://duringhealth.com/insights/medicare-edi-hipaa-transactions-basics/ https://duringhealth.com/insights/medicare-edi-hipaa-transactions-basics/ Wed, 07 Oct 2026 00:00:00 GMT Billing & Revenue Cycle Every electronic claim is a conversation: you send an 837, and a series of replies tells you whether it got in, what happened to it and what you were paid. Here is what each HIPAA transaction does, how to read the three acknowledgments, who must bill electronically, and what changed recently. https://duringhealth.com/insights/ncci-edits-explained-ptp-mue-add-on-code-edits/ https://duringhealth.com/insights/ncci-edits-explained-ptp-mue-add-on-code-edits/ Wed, 07 Oct 2026 00:00:00 GMT Coding & Compliance The National Correct Coding Initiative decides, line by line, which Medicare codes can be paid together, how many units are too many, and when a modifier is allowed to get past an edit. Here is how the three kinds of edit work, how to read a modifier indicator, which modifier to use, and what to do with a denial. https://duringhealth.com/insights/cms-0057-f-prior-authorization-2027/ https://duringhealth.com/insights/cms-0057-f-prior-authorization-2027/ Tue, 06 Oct 2026 00:00:00 GMT Digital Health & Interoperability The rule puts its obligations on payers — faster decisions, specific denial reasons, public metrics and FHIR-based APIs. But the benefits reach only the providers who are ready to use them. Here is what is already in force, what arrives on January 1, 2027, and what to do now. https://duringhealth.com/insights/medicare-physician-fee-schedule-2027/ https://duringhealth.com/insights/medicare-physician-fee-schedule-2027/ Fri, 02 Oct 2026 00:00:00 GMT Regulatory & Reimbursement CMS’s proposed CY2027 rule cuts the conversion factor, rewrites same-day E/M billing, and locks remote monitoring to in-house staff — all ahead of a final rule due in November. Here’s what to model now, and what to hold off on until the ink is dry. https://duringhealth.com/insights/agentic-ai-governance-us-health-systems/ https://duringhealth.com/insights/agentic-ai-governance-us-health-systems/ Tue, 01 Sep 2026 00:00:00 GMT Agentic AI & Automation Pilots are easy. Scaling an agent into revenue cycle or clinical documentation without a governance model is how a health system ends up explaining itself to compliance.