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…
Details
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…
Details
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…
Details
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…
Details
We find ourselves halfway through 2022 and already we’re looking forward to the end of the year to see what those 2023 documentation guideline changes will be. I am most excited to see what those changes will be as we expand 2021 documentation guidelines into other types and places of E&M services and personally, I…
Details
June 10, 2022 | By Scott Kraft, CPMA, CPC The state and federal Public Health Emergency (PHE) declarations related to the COVID-19 pandemic created wide latitude for providers to render services via telehealth in order to prevent the higher risk of in-person contact for patients, providers, and staff. Some states have taken time during…
Details
June 3, 2022 | By Pam Brooks, MHA, COC, PCS, CPC, Fellow Federal oversight makes healthcare one of the most highly regulated industries in the United States. From a compliance perspective, that oversight poses significant risk for organizations who are unaware of the federal requirements, as well as providing opportunities for compliance professionals to…
Details
You know, most of the training I see out there, and even most of the training that I’m asked to do on E&M 2021 documentation guidelines surrounds MDM, so a lot of it isn’t even on time-based. So, set your watch. Let’s spend just a few minutes talking about…time. I’d like to start off by…
Details
May 27, 2022 | By Sonal Patel, CPMA, CPC, CMC, ICDCM I have been privileged to make my entrance into the world of healthcare and medical coding, specifically after my first career as an art historian dissolved way back in 2008 due to the recession. Mind you, I have taken all my research skills,…
Details
Have you ever had one of those questions that you think you have the answer to, but the more you read it, the more you’re swayed the other way — and then you read it again and you have an even different answer? Well, one of our NAMAS members (and a friend of mine) emailed…
Details