Preventative Testing – Unique Risk Stories – Listening to your patients By Jill Young CEMC, CPC, CEDC, CIMC September 27, 2024 I am going to tell you a story about my family and their journey with Preventive Testing and colon cancer. Names have been changed to protect the innocent and some facts may have been…
Getting it right: HCC in Primary Care Rhonda Buckholtz CPC, CPMA, CDEO, CRC, CHC, COPC September 20, 2024 Many of us have a love/hate relationship depending on your role in healthcare. From a provider standpoint, most often we think of these as an administrative burden with no upside. However, a shift in thinking is needed…
July 26, 2024 By: Sean Weiss The Role of the Auditor The National Alliance of Medical Auditing Specialists (NAMAS) asked if I had any interest in writing something for their blog, and of course, I take any opportunity I get to talk or write about compliance. In this blog, I thought, “since I am…
The Well Woman Exam Crystal Tompkins CDEO, CPMA, CPC, CRC, COBGC, and Educator and Auditor September 13, 2024 I will never forget the wonder of being asked to write an article for NAMAS. The nerd in me was ecstatic, and the auditor/coder in me was completely in shock. After that feeling subsided, reality quickly set…
Safeguarding Medical Necessity in Non-face-to-face Exchanges Anna McGregor CLP, CPC, CPCO, CPMA, CPA-RA, CEMC, CEMA September 6, 2024 Has there been a moment when auditing an encounter when one wondered if this service was necessary because a reasonable indication for medical services was not identified? Should medical necessity be identified as the appropriateness of a non-face-to-face…
Here’s Your Sign… Shannon O. DeConda, CPC, CPMA, CEMA, CPA-EDU August 30, 2024 I recently visited a new provider’s office and noticed two prominent signs posted everywhere—one about a $100 no-show fee and another offering B-12 shots for cash. Surprisingly, the compliance issue isn’t with the no-show fee but with the B-12 cash service. Let’s…
Navigating Prescription Drug Medical Weight Loss Stephanie Allard, CPC, CEMA, CPA-RA, RHIT August 23, 2024 This year, a recurring issue is continuing to pop up in the audit reviews that I am completing for clients. The issue is related to medical weight loss and what I think is a complete misunderstanding in the industry regarding…
Appreciating Informed Consent in the Context of False Claims Act Liability. Rachel V. Rose, JD, MBA[A] August 16, 2024 Overview A recent settlement by the U.S. Department of Justice (DOJ) in a False Claims Act (FCA) case underscores the importance of adequate informed consent for a variety of reasons. First, it is mandated by federal…
Balancing Compliance Costs and Benefits Gene Good, JD, CPA | CEO, DoctorsManagement, LLC August 9, 2024 Some points to consider when setting your payor Compliance budget and how to show the return on your compliance investment. Whether you are a physician’s office or health system, there is ongoing pressure on margins and increasing recoupment activity…
July 26, 2024 By:Pamela Warren, MHA, COC, PCS, CPC, Fellow Auditing Surgical Services While E&M auditing continues to be the industry favorite for professional medical auditors in this field, there are several reasons and opportunities to audit surgical services. However, even though many surgeons spend a fair amount of office time in consultation with…