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…
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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…
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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…
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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…
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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…
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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…
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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,…
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January 22, 2021 | By Sean M. Weiss, CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC Welcome to 2021, “y’all” – as we say down yonder in the beautiful South! Let me begin by making it clear that the issues discussed in this article are not specific to any particular commercial or federal healthcare payer…
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January 15, 2021 | By Stephanie Allard, CPC, CEMA, RHIT CMS defines critical care as “the direct delivery by a physician(s) of medical care for a critically ill or injured patient. The care of such patients involves decision making of high complexity to assess, manipulate, and support central nervous system failure, circulatory failure, shock-like…
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January 7, 2021 | By Grant Huang, CPC, CPMA The 2021 Physician Fee Schedule (PFS) had included the largest one-year reduction to the Medicare conversion factor (CF) in more than 20 years, but it won’t actually take effect because the CF is being increased as a result of provisions in the recently passed stimulus legislation.…
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