August 7, 2020 | By By Rachel Rose, JD, MBA The Health Information Portability and Accountability Act, Pub. L. 104-191 (Aug. 1996) (“HIPAA”) is often times misapplied. Take the COVID-19 pandemic for example. Despite the U.S. Department of Health and Human Services (“HHS”) and the Office for Civil Rights (“OCR”) reiterating the exceptions present…
Details
August 15, 2020 | By Shannon DeConda, CPC, CPC-1, CPMA, CEMC, CMSCS As we migrate to the new AMA CPT Guidelines for Outpatient Office E&M visits, we mourn the loss of what has been our cozy wearing of the 1995 & 1997 Documentation Guidelines. Out of sentimental respect for the Documentation Guidelines for E&M…
Details
August 21, 2020 | By Jesse Overbay, JD On March 13, 2020, the President of the United States issued an emergency declaration under the Stafford Act to declare a national health emergency, setting in motion a chain of events for the Centers for Medicare and Medicaid Services (“CMS”) and our entire healthcare system that…
Details
September 11, 2020 | By Shannon DeConda, CPC, CPC-1, CPMA, CEMC, CMSCS Living in the “Florida’s Space Coast” we are quite attuned to hearing launch references- and we can certainly relate as we wind down to the 3-2-1 months before the new AMA E&M Guidelines are effective. Kennedy Space Center lists valuable tips for…
Details
September 25, 2020 | By Grant Huang, CPC, CPMA With two key components of E/M level selection – the history and physical exam – being eliminated as factors for choosing a code level, medical decision making (MDM) will take center stage in 2021. As we begin the final quarter of 2020, coders and auditors…
Details
October 2, 2020 | By Nicholas Goodwin, Esq. “How did that meeting go with the bank?” John asked, stopping by Dan’s door on his way to his office down the hall. “What meeting?”, Dan responded. Confused, John said “The meeting about the line of credit. You sent me an email about it this morning…
Details
October 30, 2020 | By Edward Townley, Founder, Cogent9 Consulting We use relative value units (RVUs) in many aspects of our practices. Some physician compensation arrangements are based on RVUs; other practices use them for staffing models and productivity measurements. Where did RVUs come from and how have they evolved over time? Beginning in…
Details
November 27, 2020 | By Grant Huang, CPC, CPMA Auditing evaluation and management (E/M) services furnished by resident physicians under the Medicare Primary Exception (PCE) already required a firm grasp of attestation and coding rules – but now COVID-19 throws another wrench into the works. In this audit tip, we will review the rules…
Details
December 4, 2020 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Last month, Paul Spencer, Senior Compliance Consultant of DoctorsManagement (DM) and I had the privilege of presenting to NAMAS members a course on performing a “gap” analysis in order to build a corporate compliance program that works in practice and is…
Details
December 18, 2020 | By Paul Spencer, CPC, COC “Risk adjustment,” as defined by CMS, is a method by which Medicare Advantage plans are compensated for demonstrating that the Medicare patients they cover under Part C plans are sicker than those covered under traditional Medicare or other plans. Increasingly, when I speak to practices,…
Details