Med Learn
MedLearn Publishing, a division of MedLearn Media, Inc., is a nationally recognized healthcare publishing and media firm specializing in all aspects of coding, compliance, reimbursement and the revenue cycle. For more than 30 years, MedLearn Publishing has delivered actionable answers that equip healthcare organizations to confidently meet their revenue and compliance obligations. Our clients access this information through a variety of resources, including publications, newsletters, and webcasts.
MedLearn is dedicated to fighting Non-Patient Outcome Spending (NPOS), especially in the areas of billing and compliance. NPOS is the sum of all non-frontline portions of hospital and clinic operations. You can count on us to walk you through recent and upcoming developments in niche coding, compliance and reimbursement— regardless of how complex and overwhelming they may seem. Our experts constantly watch the horizon for what’s coming, carefully research how you’ll be impacted, and articulate the steps required to keep your facility compliant and fiscally strong in a variety of settings. Source
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Recent Articles
Search ArticlesDo 340B Eligibility Rules Still Measure Hospital Need?
Congress should revisit how hospitals qualify for 340B drug discounts. H.R. 1’s Medicaid changes and court decisions affecting the Supplemental Security Income (SSI) fraction expose a weakness in the eligibility formula: a hospital can serve more financially vulnerable patients while its qualifying percentage falls. The program’s safety-net purpose remains relevant, but its measure of need deserves reconsideration.
Timely Notification of an Organization Determination: A Mandate, Not a Suggestion
Today I’m going to briefly focus on the timely notification of an organization determination, and the new rules effective since the start of this year. Here’s the scenario. A Medicare Advantage (MA) member is admitted. The hospital notifies the plan on time. And then – nothing. Days go by. The patient improves, goes home, and only then does the plan’s determination show up. Often, it’s a denial of the inpatient level of care.
More Grumblings from Dr. Hirsch – On Congress, WISeR, and HHS OIG
Late last week a new bill was proposed in Congress, titled the “Stop Corporate Takeovers of Physicians Act.” While the main intent of the bill is to limit the ability of private equity and healthcare systems to own and control medical practices, there are two parts that are baffling.
The Evolving Landscape of Litigation Targeting Tracking Technologies
Today I’m going to offer an update on “Pixel” litigation. This is a rapidly evolving area of the law, and I want to make sure we’re all up to speed. When I first talked about Pixel litigation, a lot of the cases out there involved Meta Pixel, which is a snippet of code made available by Meta meant to collect certain information about a website user. Other companies, such as Google, have similar technologies.
CJR-X and the Shrinking, Sicker Inpatient Joint Replacement Population
The Centers for Medicare & Medicaid Services (CMS) finalized the Comprehensive Care for Joint Replacement Expanded Model (CJR-X) in the Inpatient Prospective Payment System (IPPS) Final Rule for the 2027 fiscal year (FY) on July 31. Starting Jan.
UnitedHealthcare Prior Authorization Reductions and the Implications for Denials
UnitedHealthcare’s (UHC’s) plan to remove prior authorization requirements affecting roughly 1,700 procedure codes across its health plan products deserves a careful welcome. For patients, fewer approval steps could mean earlier access to needed services. For healthcare organizations, the change could reduce administrative work and prevent some authorization-related denials.
The Beauty of Skin Repair Coding
Hospital coders are geniuses. Not only must they master Current Procedural Terminology ®(CPT) principles when coding outpatient facility and all physician claims, they must adapt to a completely different transaction set, the International Classification of Disease, 10th Edition, Procedural Coding System (ICD-10-PCS) along with its completely different conventions, guidelines, and interpretations, when coding the same procedure during an inpatient encounter.
Cardiology Question for the Week of September 21, 2026
When reporting coronary intervention for an acute myocardial infarction, when is it appropriate to assign code 92941 or C9606, and what types of procedures and vessels are included in these codes?
General Question for the Week of September 21, 2026
What documentation should be reviewed before determining drug administration codes for an observation encounter? The following should be considered before determining the drug administration codes for any observation encounter: Missing start and stop times. Remember for any infusions, including hydration, the stop time needs to be documented in order to support this coding.
Laboratory Question for the Week of September 21, 2026
Can microdissection be separately reported with PLA codes? Additional procedures performed before cell lysis, such as microdissection, may be separately reported when performed and appropriately documented. However, scraping tumor from an unstained slide is considered included in the payment for the molecular pathology procedure, and codes 88380 or 88381 should not be reported for this process, per the 2026 NCCI Policy Manual.