June 10, 2022 | By Scott Kraft, CPMA, CPC The state and federal Public Health Emergency (PHE) declarations related to the COVID-19 pandemic created wide latitude for providers to render services via telehealth in order to prevent the higher risk of in-person contact for patients, providers, and staff. Some states have taken time during…
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June 3, 2022 | By Pam Brooks, MHA, COC, PCS, CPC, Fellow Federal oversight makes healthcare one of the most highly regulated industries in the United States. From a compliance perspective, that oversight poses significant risk for organizations who are unaware of the federal requirements, as well as providing opportunities for compliance professionals to…
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May 27, 2022 | By Sonal Patel, CPMA, CPC, CMC, ICDCM I have been privileged to make my entrance into the world of healthcare and medical coding, specifically after my first career as an art historian dissolved way back in 2008 due to the recession. Mind you, I have taken all my research skills,…
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May 20, 2022 | By Toni Elhoms, CCS, CPC, CPMA, CRC Over the past year and a half, I have seen a significant increase in the volume of Unified Program Integrity Contractor (UPIC) investigations taking place in private physician practices. UPICs work on behalf of CMS to perform program integrity functions like detecting fraud,…
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November 5, 2021 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Terry Fletcher sits down with our very own Sean M. Weiss to discuss how physicians become audit targets. Terry joins Sean monthly on the compliance guy for her #TerryTuesday segment. We know you’ll enjoy it! Listen Now
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An ortho client emailed an interesting question this past week that is a good one to think through. For post-op major joint replacement patients, they would like to send their RN to the patient’s home for follow-up check-in visits. They wanted to provide this as an optional cash pay service. As a compliance forward auditor,…
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May 13, 2021 | By Rhonda Buckholtz, Owner, Coding and Reimbursement Experts For years we have talked about the culture in healthcare, especially for compliance purposes but for many practices that culture takes a back seat despite continued guidance. Culture is one of the most important features of a medical practice and for compliance…
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November 12, 2020 | By Priscilla J. Alfaro, MD, FAAP, CPC, CPMA, COC, CFE Genetic testing has grown exponentially over the last decade. The elimination of patent protection on human genes, the proliferation of next-generation sequencing (NGS) technology, and the rapid discovery of gene-disease connections have all contributed to this trend. * The rapidly…
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February 18, 2022 | By Stephanie Allard, CPC, CEMA, RHIT When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally. First, we must…
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April 8, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Four months into 2022 and the question is: How far along is your audit of high, medium, and low-risk services? If you are like most practices or health systems, something always gets in the way and causes audits to take…
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