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NAMAS MEDICAL AUDITING AND COMPLIANCE

Let’s Talk About Weed (As in the Doctor…)

2023 AMA Updates, Evaluation & Management: 2021 & BeyondBy NAMASOctober 6, 2022

  October 7, 2022 | By J. Paul Spencer, CPC, COC Early September marked my 33rd year on the administrative side of healthcare. This followed my 56th birthday in April when I officially entered the realm of “pushing 60”. Once you get to be my age, the reaction to my opinion falls into one of…

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The One Where The Code is IN the Documentation

Compliance, CPT, ICD-10, Payer Rules, Today's TakeBy NAMASOctober 4, 2022

Have you given much thought to an encounter that you might review that actually has CPT or ICD-9 codes documented or included right in the EMR-produced note? (Yes, I do start off many conversations just that way. To be in my head… it’s a scary thing!) So, here’s my question to you: What happens when…

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DENIED! CO 22-This care may be covered by another payer, per coordination of benefits?!?

Payer RulesBy NAMASSeptember 29, 2022

  September 30, 2022 | By Christine Hall, Senior Consultant, CHC, CPC, CPB, CPMA, CRC, CEMC, CPC-I Certified Instructor   Coordination of benefits can be described as when two or more insurance plans work together to determine the order of coverage liability. This coordination between plans exists to avoid duplicate payment, which could result in…

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Up-Coding and Down-Coding: The Yin-Yang of Coding Evaluation and Management Services

Compliance, E/M Coding & AuditingBy NAMASSeptember 23, 2022

  September 23, 2022 | By Sonal Patel, CPMA, CPC, CMC, ICDCM Can I be honest here? I am thrilled that I am finished with the 1995 and 1997 (“95 and 97”) evaluation and management (“E/M”) guidelines for office and outpatient visits. Okay, okay, obviously I am not serious, but I am happy seeing that…

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Corrective Action Plan: The Demand from Payors

ComplianceBy NAMASSeptember 16, 2022

  September 16, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Audits are nothing new but the requirements tied to them are in a lot of cases. For years I have talked about and encouraged clients to create Corrective Action Plans (CAPS) when they uncover something that requires adjustments and possibly…

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Recent Posts
  • Auditing Moderate (Conscious) Sedation Services
  • Auditing the AMA’s New Telemedicine Evaluation and Management (E/M) Codes: 98000–98016
  • Billing Battles: What to Do When Billing Instructions Don’t Add Up
  • Ancillary Staff vs. Reimbursable Providers: Navigating CMS and Commercial Payor Rules
  • Why Medical Claims Auditors Should Embrace Autonomy for Non-Physician Qualified Providers
  • CCM Under the Microscope: Are Your Providers Documentation-Ready?
  • Before You Bill Incident To—Is the Treatment Plan Really There?
  • Prescription Drug Management Requires More Than a Medication List
  • Non-Medically Necessary vs. Statutorily Excluded Services: Understanding the Differences
  • Prevention of Patient Complaints and Payer Denials: Covered vs Non-Covered Preventive Services
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