March 12, 2021 | Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content, innoviHealth Because deaths due to drug overdose is a nationwide epidemic, federal, state, and private organizations created substance use disorder (SUD) programs to treat patients who abuse alcohol or other illicit substances, or who have a history of prolonged…
March 5, 2021 | By Stephanie Allard, CPC, CEMA, RHIT When I begin to work with a new client on an auditing project, I like to set up a meeting with them before we begin, to talk through the steps that I take as an auditor and to discuss their reason for the audit…
March 26, 2021 | By Jamee Black, CPC, COC, CPMA The American Medical Association (AMA) recently released changes to the current Evaluation and Management (E/M) documentation guidelines for the Office and Other Outpatient Visit code range (99202–99215). The new guidelines focus on medical decision making (MDM), and are intended to more closely reflect the…
February 19, 2021 | By David Carpenter Critical care billing is relatively simple. Documentation requires three items – The patient is critically ill. What the provider is doing to treat or prevent organ system failure or compromise. How much time the provider spent providing critical care. While critical care billing is relatively simple,…
February 12, 2021 | By Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA, CEMA-O A few weeks ago, NAMAS presented a webinar about 2021 time and prolonged services. The flood of participant questions made it very obvious there is still uncertainty about how to appropriately use time to select the level of office…
February 5, 2021 | By Paul Spencer, CPC, COC As coders, auditors, and practitioners, we now find ourselves one month into the new world of outpatient evaluation and management (E/M) services. By now, certain patterns are hopefully beginning to emerge with regard to providers’ E/M documentation. As templates change and providers make the choice…
January 29, 2021 | By Scott Kraft, CPMA, CPC One of the big changes in the new E/M Documentation Guidelines for 2021 for office and outpatient service codes 99202-99215 is the new high-risk category of “Decision Regarding Hospitalization.” As an auditor, the first thing I thought about were the situations in which a very…
January 22, 2021 | By Sean M. Weiss, CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC Welcome to 2021, “y’all” – as we say down yonder in the beautiful South! Let me begin by making it clear that the issues discussed in this article are not specific to any particular commercial or federal healthcare payer…
January 15, 2021 | By Stephanie Allard, CPC, CEMA, RHIT CMS defines critical care as “the direct delivery by a physician(s) of medical care for a critically ill or injured patient. The care of such patients involves decision making of high complexity to assess, manipulate, and support central nervous system failure, circulatory failure, shock-like…
January 7, 2021 | By Grant Huang, CPC, CPMA The 2021 Physician Fee Schedule (PFS) had included the largest one-year reduction to the Medicare conversion factor (CF) in more than 20 years, but it won’t actually take effect because the CF is being increased as a result of provisions in the recently passed stimulus legislation.…