April 8, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Four months into 2022 and the question is: How far along is your audit of high, medium, and low-risk services? If you are like most practices or health systems, something always gets in the way and causes audits to take…
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You know, those conversations you have between another coder and auditor or better yet, those difficult conversations with a physician about the mechanics of the code vs. the intent of the code? That’s what I want to discuss today. Sometimes this gets lost and it gets the better of us as a coder and/or auditor.…
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May 6, 2022 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT A great deal of time was spent this year with new coding updates focusing on critical care split shared updates, but not much time was given to all of the other red-lined updates in the critical care section of the CMS Claims…
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April 22, 2022 | By Grant Huang, CPMA, CPC Prolonged services have been around for a long time – no pun intended – but in recent years the number of codes involved has grown and their requirements have changed, making them a potentially risky area for providers. For this reason, auditors should take the…
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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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April 4, 2022 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT Today, I want to bring you a little educational tidbit on E&M documentation improvement and how to audit those challenging sections of E&M. We’re going to take a look at the third column of our MDM table, the Risk of Complications for…
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April 1, 2022 | By Ray Dunkle, CPA, CFE, CGMA Stakeholders are becoming increasingly interested in companies that value ethical business practices. From employees to investors, people are looking for businesses that adhere to strict environmental, social, and governance (ESG) criteria. In the following, we will explore the importance of an ESG program as…
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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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