February 28, 2020 | By Daniel F. Shay, Esq. Facing the mounting pressure of demographics, the Medicare system looks to slow the outflow of money however it can. One of the chief targets of these efforts is the process by which providers obtain Medicare billing privileges (“enrollment”). Without being enrolled in Medicare, a provider…
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February 21, 2020 | By Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA, CEMA-O In the first three articles of this series, we explored how the 2021 E&M changes to office visits will affect each element of medical decision making (MDM): diagnoses, data, and the table of risk. In this article, 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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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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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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January 24, 2020 | By Frank Cohen, Director of Analytics and Busines Intelligence The first thing to note is that I am not an auditor. So, for me to write an article on auditing tips might seem a bit out of place. But this is not an article on auditing compliance but rather…
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January 19, 2020 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Welcome to 2020! It is my hope that all of you had a great holiday season and New Year and are well-rested and ready to take on the challenges of this new year head-on and armed with the necessary…
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January 10, 2020 | By David Glaser Skepticism is a vital trait in the coding and billing process. Constant questioning is necessary because when you receive guidance from consultants and contractors it may be both clear and categorical, but it’s possible that upon objective review, you will realize it is also cockamamie. For…
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January 8, 2020 | By Shannon DeConda, CPC, CPC-I, CEMC, CMSCS, CPMA It is truly amazing to finally begin to see new reimbursement opportunities for services that providers have given for years without compensation. One such area is in a new code set this year for Behavior Assessment & Intervention. This code…
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December 31, 2019 | By Stephanie Allard, CPC, CEMA, RHIT As of January 1, 2020, CPT made changes to the health and behavior assessment and intervention codes (96150-96155) and therapeutic interventions that focus on cognitive function (97127). If you code and audit services in this category, you must pay close attention to…
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