August 27, 2021 | By Jamee Black, CPC, COC, CPMA One of the most difficult determinations of Number and Complexity of Problems Addressed is complicated vs uncomplicated. When selecting Number and Complexity of Problems Addressed, the complication of treatment required should not be considered. The Risk of Complications of Patient Management is where the treatment…
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August 20, 2021 | By J. Paul Spencer, CPC, COC In my role as a compliance consultant specializing in carrier audit response, a lot of items are brought to my attention on a daily basis, with the bearer of said items asking questions such as, “What’s this?” and “Do I have to respond to…
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August 13, 2021 | By Grant Huang, CPC, CPMA With Americans having widespread access to effective vaccines, the COVID-19 pandemic is finally fading into the background for most practices, but the issue of compliance is once again rearing its multi-faceted head. This time, after billions of dollars in federal spending as part of pandemic…
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August 6, 2021 | By Sean M. Weiss, CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC 2021 has lived up to what, in my mind, I’ve dubbed back in December of 2020 “The Year of The Audit”. The number of “raids”, resolution agreements, settlement agreements, and audits by RACs, SMRCs, UPICs, and SIUs have…
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July 30, 2021 | By Scott Kraft, Auditing Specialist, DoctorsManagement While payers have increasingly turned away from covering consultation services, this type of billing is not extinct yet. Consultations can be done in the office and inpatient setting, and just as a refresher, are billed when a provider is requesting the professional opinion of…
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July 23, 2021 | By Rachel Rose, JD, MBA In June 2021, the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) issued Issue Brief, OEI-01-20-00220 (hereinafter “Issue Brief”), which highlighted the results of its review of cybersecurity for networked medical devices in hospitals. The impetus behind the review was…
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July 16, 2021 | By David Glaser On May 3rd CMS pulled the shared visit language from the Manuals. The government has increasingly recognized that only statutes and regulations can limit Medicare coverage, so when something in the Manuals is not contained in either a federal law or a federal regulation, it is not binding.…
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July 9, 2021 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT After 6 months of speaking to the 2021 AMA guidelines, many of you may be tired of talking about the new documentation guidelines. But the other half of us are frustrated at still seeing documentation come through that represents the mandated…
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July 2, 2021 | By Pam Brooks, MHA, COC, CPC As an auditor, you might find that the “meat and potatoes” of the audit is the most interesting part. Then you finish and it is time to pull together your findings into an executive summary. The best and most effective executive summary design is…
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June 25, 2021 | By Stephanie Allard, CPC, CEMA, RHIT When I ask practices if they have been through an external audit recently, they typically will state “no” or let me know if recent requests for a larger number encounter notes have been received. Through these conversations, I realize that they are not noticing…
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