August 5, 2022 | By Michele Strickland, CPC, CEMA Incident-To is often discussed in coding and compliance circles, but when reviewing encounters, I routinely find the criteria fails to meet or support the billing of non-physician practitioners (NPPs) and/or other clinical staff (auxiliary). There are two types of Incident-To services; a component of the service…
Strategic Litigation Services | CEMA Certification | Audit Services Details of the Case From Expert Witness Sean M. Weiss Recently, Sean M. Weiss with NAMAS’ parent company DoctorsManagement testified as an expert witness in a federal court case against four healthcare providers in one of the largest Medicare/Medicaid fraud cases in U.S. history. Read below as Sean recaps…
April 22, 2022 | By Grant Huang, CPMA, CPC You’ve taken the time to complete a painstaking audit of a provider, combing through their documentation on an EHR or maybe even navigating through a handful of handwritten notes. You’ve calculated their score – it doesn’t look too good – and now it’s time for…
The 2023 AMA documentation guidelines hit us on June 30th -and I’ve had a chance to read through them. I want to remind you that while we have the AMA changes, we don’t yet have the final rule from CMS. We don’t know how CMS is going to process all of these changes. As you’re…
July 15, 2022 | By J. Paul Spencer, CPC, COC Chances are, based on who we are and what we do, we’ve all been there. Out of nowhere, completely out of context of our day-to-day work as auditors and administrative professionals in the world of healthcare, a conversation is started with someone who is…
July 8, 2022 | By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM According to the U.S. Department of Health and Human Services (HHS) and the Office of Inspector General website, things have changed in regard to the controversial question of mandatory compliance plans. The Federal Register…
July 1, 2022 | By Stephanie Allard, CPC, CEMA, RHIT After all the hype surrounding the upcoming Cigna policy regarding modifier 25 and pre-bill reviews, it seems as if Cigna is not planning on implementing the policy as planned on August 14, 2022. At the time I am writing this, there is recent news…
June 24, 2022 | By Rachel Rose, JD, MBA By now, providers should appreciate that there are legal ways to structure most arrangements. One area that is fraught with peril are physician owned distributorships, which are also referred to as “PODs”. PODs are defined as: “physician-owned entities that derive revenue from selling, or arranging…
When you’re providing audit feedback or education for providers, have you been receiving pushback or comments from providers regarding qualification time statements? When we think about the qualification statement that is required, well…best practices, for our time-based E&M services, those qualification statements are really needed in order to qualify the amount of time that our…
June 17, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC I am constantly being asked what can be done when government and commercial payors are slow-walking claims for payment. The simple answer is to know your state and federal law. First, let’s tackle the federal law which is 42 CFR…