October 23, 2020 | By Grant Huang, CPC, CPMA It’s not even 2021 yet, but gray areas have already surfaced in the 2021 E/M documentation guidelines, as more and more coders and auditors read the fine print. The 2021 guidelines, which will apply only to outpatient/office visit codes 99202-99215, are being implemented in part…
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December 15, 2020 | By By Grant Huang, CPC, CPMA At long last, CMS has published its Medicare Physician Fee Schedule (PFS) final rule, and while some of the provisions will be widely felt across many specialties, there are no major or unexpected deviations from the proposed rule. The agency typically releases the PFS…
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December 25, 2020 | By By Grant Huang, CPC, CPMA The New Year is nearly upon us and with it, implementation of the much-talked-about 2021 E/M guidelines for office/outpatient codes 99202-99215. These guidelines include completely revamping how time works for selecting code levels, which in turn has resulted in brand new rules for prolonged…
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January 1, 2021 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT While conducting a 2021 E&M Physician Training event for a client, like right in the middle of the session, I had an epiphany. Now maybe you have already had it- but I thought- WOW- we have made the full circle right back around…
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January 29, 2021 | By Scott Kraft, CPMA, CPC One of the big changes in the new E/M Documentation Guidelines for 2021 for office and outpatient service codes 99202-99215 is the new high-risk category of “Decision Regarding Hospitalization.” As an auditor, the first thing I thought about were the situations in which a very…
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February 5, 2021 | By Paul Spencer, CPC, COC As coders, auditors, and practitioners, we now find ourselves one month into the new world of outpatient evaluation and management (E/M) services. By now, certain patterns are hopefully beginning to emerge with regard to providers’ E/M documentation. As templates change and providers make the choice…
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April 24, 2020 | By Stanley Nachimson, Nachimson Advisors After a lengthy period of comments and discussions with industry leaders and vendors, the final Interoperability Rules for EHRs and health plans were released by HHS. These rules contain a myriad of technical and policy requirements for the electronic exchange of standardized data among providers…
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May 1, 2020 | By Stephanie Allard, CPC, CEMA, RHIT Over the years I have found that one of the main risks to an organization are employees who get comfortable in their positions to the point where the explanation for or response to an audit variance is “that is how we have always…
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May 8, 2020 | By Paul Spencer, CPC, COC Time, as it applies to procedures and services, is a vastly misunderstood portion of the Resource Based Relative Value Scale (RBRVS), the methodology used to generate the relative value units (RVUs) that determine the payment for every CPT code. For many years, information on the…
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May 15, 2020 | By Stephanie Allard, CPC, CEMA, RHIT Over the past month, I have heard comments wondering why we would continue to audit during the COVID-19 public health emergency (PHE). Many commented that with so much going on, there is not enough time, and the encounters are now telehealth so what is…
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