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NAMAS MEDICAL AUDITING AND COMPLIANCE

2021 E&M: Order and Review for INPATIENT

2023 AMA Updates, E/M Coding & Auditing, Evaluation & Management: 2021 & Beyond, Today's TakeBy NAMASOctober 17, 2022

The 2021 documentation guidelines for INPATIENT services will be effective on January 1st, 2023, and we hope you’re ready! What I want to address in this post relates to the middle column; Data. This has proven to be a problem in the office setting, which was our first rollout, and I can tell you, I…

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Medicare MACs, SMRC, UPIC/ZPIC, and RACs: Why Can’t You Just Comply?

Compliance, Legislative Action, Payer RulesBy NAMASOctober 13, 2022

  October 14, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Why is it that payors often, can’t or won’t comply with their own reimbursement rules or guidelines for processing/adjudicating claims? Some (who are contracted to The Centers for Medicare and Medicaid Services (CMS)) may view this blog in a negative…

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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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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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