A question that I get asked repeatedly, that I haven’t taken the time to address in a long time, came up on a webinar that I was doing for orthopedic executives and coders. What happens when a provider sees a patient and then later finds out that they were a resident of a Skilled Nursing…
June 2, 2023 | By Grant Huang, CPMA, CPC You’ve got just over a month before July 1, the day that modifier JZ (zero drug wasted) becomes mandatory on all claims for drugs in single-use containers that are used up without wastage. It’s a seemingly simple change that is being backed up by explicit…
May 26, 2023 | By Stephanie Allard, CPC, CEMA, RHIT Most of us, if not all of us, have heard the statement, “If it isn’t documented, then it wasn’t performed.” While I know this is often the perspective of payors, I cringe when I hear this, thinking about all the providers that I work…
May 19, 2023 | By Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM Unless you have been climbing Mount Everest alone with no cell or Wi-Fi services for the past few months, I am certain you have heard of ChatGPT and its use as a form…
May 12, 2023 | By Scott Kraft, CPMA, CPC The E/M Documentation Guidelines implemented in 2021 essentially place, time and medical decision making on equal footing. When visit time is documented, the service can be coded based on whichever of time and medical decision making is most favorable to the provider. This has led…
May 5, 2023 | By Stacie L. Buck, RHIA, CCS-P, RCC, RCCIR, CIRCC It is no secret that interventional radiology is one of the most difficult specialties for coders and auditors to master. In particular, coding correctly for embolization procedures can be tricky due to the multiple coding considerations involved. This article provides tips…
March 28, 2023 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT With the adaptation of 2021 Guidelines and the reduction in documentation requirements, many coders and auditors had thought the use of copy and paste may begin to phase out. Unfortunately, this has not been the case, primarily because many providers are still…
May 20, 2022 | By Toni Elhoms, CCS, CPC, CPMA, CRC I know I am not the only one who is completely appalled by the recent bombshell story on Cigna’s shady claims adjudication practices. ProPublica recently published a scathing article that pulls back the curtain on “PXDX” – a cost-containment strategy deployed by Cigna…
April 14, 2023 | By David Glaser It’s almost a staple at conferences attended by coders: you should have insurance! And be careful to make sure you aren’t going to jail! But while these scary speeches may be common, that doesn’t make them accurate. The reality is that it is very, very rare…
April 7, 2023 | By Rachel Rose, JD, MBA Overview Whenever I present, which is often, I often receive follow-up questions from participants regarding resources to utilize when creating, reviewing, and/or supplementing a compliance program, including relevant policies and procedures. One resource which should be utilized is the Health Care and Public Health Sector…