August 20, 2021 | By J. Paul Spencer, CPC, COC In my role as a compliance consultant specializing in carrier audit response, a lot of items are brought to my attention on a daily basis, with the bearer of said items asking questions such as, “What’s this?” and “Do I have to respond to…
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March 26, 2021 | By Jamee Black, CPC, COC, CPMA The American Medical Association (AMA) recently released changes to the current Evaluation and Management (E/M) documentation guidelines for the Office and Other Outpatient Visit code range (99202–99215). The new guidelines focus on medical decision making (MDM), and are intended to more closely reflect the…
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July 30, 2021 | By Scott Kraft, Auditing Specialist, DoctorsManagement While payers have increasingly turned away from covering consultation services, this type of billing is not extinct yet. Consultations can be done in the office and inpatient setting, and just as a refresher, are billed when a provider is requesting the professional opinion of…
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August 13, 2021 | By Grant Huang, CPC, CPMA With Americans having widespread access to effective vaccines, the COVID-19 pandemic is finally fading into the background for most practices, but the issue of compliance is once again rearing its multi-faceted head. This time, after billions of dollars in federal spending as part of pandemic…
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August 6, 2021 | By Sean M. Weiss, CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC 2021 has lived up to what, in my mind, I’ve dubbed back in December of 2020 “The Year of The Audit”. The number of “raids”, resolution agreements, settlement agreements, and audits by RACs, SMRCs, UPICs, and SIUs have…
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July 23, 2021 | By Rachel Rose, JD, MBA In June 2021, the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) issued Issue Brief, OEI-01-20-00220 (hereinafter “Issue Brief”), which highlighted the results of its review of cybersecurity for networked medical devices in hospitals. The impetus behind the review was…
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July 16, 2021 | By David Glaser On May 3rd CMS pulled the shared visit language from the Manuals. The government has increasingly recognized that only statutes and regulations can limit Medicare coverage, so when something in the Manuals is not contained in either a federal law or a federal regulation, it is not binding.…
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January 31, 2020 | By Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA, CEMA-O The year 2021 will bring significant changes to how we determine the level of evaluation and management services in the outpatient setting. We will no longer score history and exam elements, instead focusing on medical decision making or…
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February 7, 2020 | By Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA, CEMA-O Previously we explored the 2021 changes that effect how diagnoses will be scored. Today we will dive into the changes to the data element of MDM. We know the year 2021 will bring significant changes to how we…
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February 14, 2020 | By Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA, CEMA-O Next year will see the implementation of significant changes to E&M guidelines, reducing the emphasis on the history and exam components while highlighting medical decision making (M.D.M.). In our last audit tip on the E&M changes, we discussed…
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