March 25, 2022 | By Kim Jolivette Williams Medical terminology related to abortions can be puzzling, but it is essential to understand the differences. Having a clear comprehension of several abortions terms is a vital component to achieve successful coding. First, let’s cover what is anesthesia. Per the ASA- American Society of Anesthesiologists, General Anesthesia…
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March 18, 2022 | By Rachel Rose, JD, MBA Enacted in 1972, the Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) remains a government enforcement favorite, despite being described by some as archaic. As articulated by the U.S. Department of Health and Human Services – Office of the Inspector General (HHS-OIG), “[t]he five most important Federal…
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March 11, 2022 | By Grant Huang, CPMA, CPC For the first time since CMS and the AMA implemented their 2021 revisions to office/outpatient evaluation and management (E/M) guidelines, we now have data on how those revisions may have impacted actual E/M code selection by healthcare providers. Utilization of level 4 visits is up…
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February 25, 2022 | By J. Paul Spencer, CPC, COC As an auditor in the post-2021 E/M landscape, one of the more common questions I receive has to do with one of the bullet points found in the “Moderate” line of the new E/M grid labeled “Number and Complexity of Problems Addressed”. While this…
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February 4, 2022 | By Scott Kraft, CPMA, CPC Medicare is making big changes to its policies for billing split/shared visits. While the main policy shifts take place in 2023, there are important changes to the rules for split/shared services in 2022 that must be followed for these services to be covered and billable…
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February 1, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC As 2022 kicks into full gear one of the biggest areas providers (*rendering services in hospitals) face a change is tied to the 2022 CMS Split/Shared Visit Rules and what the anticipated impact(s) will be (here is a link…
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January 28, 2022 | By David Glaser The No Surprise Billing Act may be the most poorly written, difficult to understand set of regulations I have encountered in my legal career. Stark is much, much easier to understand. Much of the guidance out there is misleading, if not entirely wrong. Here is a short…
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January 21, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC While I am sure you have heard it several dozen times by now, I want to welcome you to 2022 because that is where the pleasantries end. 2022 will see Medical Necessity put front & center not only in audits…
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January 14, 2022 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT In 2022, when we sit down to configure an audit plan, we often consider whether we will perform an audit retrospectively or prospectively and whether the sample will include evaluation and management (E&M) services, procedures or some combination of them both. What we…
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January 7, 2022 | By Toni Elhoms, CCS, CPC, CPMA, CRC It’s our favorite time of the year again – coding and regulatory compliance update season! As I’m sure many of my compliance colleagues can relate, this is the time of the year when we get inundated with “Can I pick your brain” requests…
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