THE RECAP An announcement on Monday, January 30th, by the OMB (Office of Management and Budget), and the White House, stated that they plan to end the COVID-19 national emergency and public health emergency on May 11th. The end of the emergency declarations would signal a new chapter in the Biden administration’s response to the…
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January 27, 2023 | By Stephanie Allard, CPC, CEMA, RHIT A large part of the last 6 months for auditors and educators has been spent in preparation for the new 2023 revisions to the 2021 E/M guidelines. For some of the patient settings, this is a large change. While many see the 2021 E/M…
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January 13, 2023 | By J. Paul Spencer, CPC, COC A major change to appeals submissions is set to begin on February 1st, 2023 that will effect practices and facilities across the country. United Healthcare (UHC) is mandating the submission of electronic reconsiderations and appeals for most types of claims and plans under their…
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January 19, 2023 | By Scott Kraft, CPMA, CPC Practices and providers can bill monthly chronic pain management services for Medicare patients beginning in 2023, using two new HCPCS G codes: G3002 and G3003. But these new codes come with specific guidelines that auditors will need to be on the lookout for when providers…
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Today’s Take is about independent interpretation, and I know we’ve talked about this before, but I think this is one we’ll have to discuss a lot. Recently I got a question about this topic from Tracy (Hi Tracy! I’m glad to answer your question.) So, Tracy explained that her providers are pain management providers and…
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January 13, 2023 | By J. Paul Spencer, CPC, COC I received a great question the other day, and I thought it was a great stepping-off point for a discussion in this space. It’s 2023, and a patient is placed in observation status by an admitting physician. A non-admitting physician is called in for…
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How many charts have you guys already audited in 2023? That’s a really big question. I hope you’re already starting to discuss your audit plan for 2023. It’s not too early, and I hope you’ve already started actually auditing charts for 2023. I recently sent out an audit tip that addressed productivity and quality production…
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January 6, 2022 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT Leaning into a new year, as I sit to write this audit tip, I am reflecting on questions that we have been asked throughout 2022 and wondering if any of these might help everyone launch a new year with greater perspective. Well,…
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Most of you are familiar with the medical necessity of the E&M encounter prior to 2021 documentation guidelines. But how does that equate in 2021? Today, we’re going to talk about how to understand medical necessity and 2021 documentation guidelines in the auditing of your encounters. Let’s take a look at the medical decision making…
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In Today’s Take, let’s discuss the difference between preventive care. You might be thinking this is “101”. But it really isn’t. Oftentimes, when conducting chart audits, we not only we see issues with a lack of documentation criteria, especially with Medicare preventive services, but we also see confusion regarding the lack of interpretation about what…
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