November 10, 2023 | By Toni Elhoms, CCS, CPC, CPMA, CRC On countless occasions, I have heard physicians and healthcare providers balk at the notion of learning how to level their E/M services based on medical-decision-making (MDM), and some will even go as far as to say things like “I don’t have time…
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Understanding the difference between Locums Tenens and Reciprocal Written by: Natasha Timberlake, BSHCM, CRCR, CPC, COC, CPMA, CHONC, CPC-I, CEMA One of the most complex parts of writing an article is deciding where to begin, especially when dealing with a subject or specialty in which we have less experience. However, the best part of writing…
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First published on TerryFletcher.netThis is a revision by the same author:Terry Fletcher CPC, CCC, CEMC, CCS, CCS-P, CMS, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM, PACS We have been receiving many inquiries and emails regarding the billing of Audio Only Telehealth for Medicare and Commercially Insured patients starting January 1st, 2025. The published guidance is…
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The Cautionary Tale of CMS’s New Policies for Global Surgery Payment Accuracy January 10, 2025 | Shannon O. DeConda, CPC, CPMC, CEMC, CEMA, CPA-EDU, CRTT, CPA-R The Centers for Medicare & Medicaid Services (CMS) continues to refine policies to address the evolving needs of the healthcare system, with an eye on accuracy and fairness…
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Understanding Independent Interpretation in E/M Coding: Three Essential Requirements Shannon O. DeConda, CPC, CPMA, CEMA, CPA-EDU October 4, 2024 In the realm of Evaluation and Management (E/M) coding, independent interpretation is an often misunderstood component of the Medical Decision Making (MDM) table. Proper documentation of independent interpretation is required to impact the MDM and, consequently,…
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No Distractions, Just Growth: The NAMAS Difference Author: Shannon O. DeConda Date: October 18, 2024 Over the past 16 years, the NAMAS Conference has transformed in many ways, but one thing has remained constant: its commitment to delivering exceptional education. This enduring dedication to education is the reason I am so passionate about hosting the…
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Insurance Discrimination – Against the Provider Author: Jeana M. Singleton, Esq. When the concept of “insurance discrimination” rears its ugly head, we often think of it in the context of when an insurance company treats some people differently than others based on protected classes, such as race, national origin, sex, or religion. Sometimes, this type…
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November 15, 2024 | By Scott Kraft, CPMA, CPC When I audit services performed in an infusion center, I’m addressing two key questions. First, were all of the patient’s infusion, injection, and/or hydration services documented appropriately for what is being billed? Second, if evaluation and management services were performed, were they medically necessary and…
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November 22, 2024 | By Jordan Johnson, MSHA Coding for oncology services is an intricate task, requiring attention to detail, a deep understanding of clinical workflows, and the ability to navigate multiple systems and payer requirements. In radiation oncology, services often span multiple months, with a patient’s treatment involving 30-50 Current Procedural Terminology (CPT)…
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November 29, 2024 | By Terry A. Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM, PACS Telehealth 2025: The Final Rule CMS issued the calendar year (CY) 2025 Medicare Physician Fee Schedule (MPFS) final rule on Nov. 1, 2024, publishing guidance that will have providers and coders scratching…
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December 06, 2024 | By Pam Warren, MHA, COC, CPC, Fellow It is very important to healthcare providers and leaders that the work auditors perform, the results auditors report and the recommendations auditors make are valid. An auditor’s reputation is dependent upon audits that are legitimately performed and accurately reported. If audits are perceived…
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