March 11, 2022 | By Grant Huang, CPMA, CPC For the first time since CMS and the AMA implemented their 2021 revisions to office/outpatient evaluation and management (E/M) guidelines, we now have data on how those revisions may have impacted actual E/M code selection by healthcare providers. Utilization of level 4 visits is up…
February 25, 2022 | By Bryan Meek, Esq., Brennan, Manna, and Diamond The Department of Health and Human Services published three parts to the No Surprises Act towards the end of 2021, which took effect January 1, 2022. The Act is intended to protect consumers from “balance billing,” which occurs when a patient receives…
February 25, 2022 | By J. Paul Spencer, CPC, COC As an auditor in the post-2021 E/M landscape, one of the more common questions I receive has to do with one of the bullet points found in the “Moderate” line of the new E/M grid labeled “Number and Complexity of Problems Addressed”. While this…
An ortho client emailed an interesting question this past week that is a good one to think through. For post-op major joint replacement patients, they would like to send their RN to the patient’s home for follow-up check-in visits. They wanted to provide this as an optional cash pay service. As a compliance forward auditor,…
February 18, 2022 | By Stephanie Allard, CPC, CEMA, RHIT When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally. First, we must…
February 11, 2022 | Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content, innoviHealth How have you felt when you embarked upon an audit, expecting to find certain basic standards of documentation to be present, but instead found them missing? Do you pull out your favorite red pen, grab a cup of…
February 4, 2022 | By Scott Kraft, CPMA, CPC Medicare is making big changes to its policies for billing split/shared visits. While the main policy shifts take place in 2023, there are important changes to the rules for split/shared services in 2022 that must be followed for these services to be covered and billable…
February 1, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC As 2022 kicks into full gear one of the biggest areas providers (*rendering services in hospitals) face a change is tied to the 2022 CMS Split/Shared Visit Rules and what the anticipated impact(s) will be (here is a link…
January 28, 2022 | By David Glaser The No Surprise Billing Act may be the most poorly written, difficult to understand set of regulations I have encountered in my legal career. Stark is much, much easier to understand. Much of the guidance out there is misleading, if not entirely wrong. Here is a short…
January 21, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC While I am sure you have heard it several dozen times by now, I want to welcome you to 2022 because that is where the pleasantries end. 2022 will see Medical Necessity put front & center not only in audits…