May 6, 2022 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT A great deal of time was spent this year with new coding updates focusing on critical care split shared updates, but not much time was given to all of the other red-lined updates in the critical care section of the CMS Claims…
Details
April 22, 2022 | By Grant Huang, CPMA, CPC Prolonged services have been around for a long time – no pun intended – but in recent years the number of codes involved has grown and their requirements have changed, making them a potentially risky area for providers. For this reason, auditors should take the…
Details
April 15, 2022 | Edward Townley CPC, CEMC, CUC, ROCC, Founder, Cogent9 Consulting The action cycle for process improvement may be defined by the Plan-Do-Study-Act (PDSA model) (i.e., the Deming cycle or Shewhart cycle). Lean/Six Sigma process improvement processes use another acronym, DMAIC (Define, Measure, Analyze, Improve and Control). All of these processes are…
Details
April 4, 2022 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT Today, I want to bring you a little educational tidbit on E&M documentation improvement and how to audit those challenging sections of E&M. We’re going to take a look at the third column of our MDM table, the Risk of Complications for…
Details
April 1, 2022 | By Ray Dunkle, CPA, CFE, CGMA Stakeholders are becoming increasingly interested in companies that value ethical business practices. From employees to investors, people are looking for businesses that adhere to strict environmental, social, and governance (ESG) criteria. In the following, we will explore the importance of an ESG program as…
Details
March 25, 2022 | By Kim Jolivette Williams Medical terminology related to abortions can be puzzling, but it is essential to understand the differences. Having a clear comprehension of several abortions terms is a vital component to achieve successful coding. First, let’s cover what is anesthesia. Per the ASA- American Society of Anesthesiologists, General Anesthesia…
Details
March 18, 2022 | By Rachel Rose, JD, MBA Enacted in 1972, the Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) remains a government enforcement favorite, despite being described by some as archaic. As articulated by the U.S. Department of Health and Human Services – Office of the Inspector General (HHS-OIG), “[t]he five most important Federal…
Details
March 11, 2022 | By Grant Huang, CPMA, CPC For the first time since CMS and the AMA implemented their 2021 revisions to office/outpatient evaluation and management (E/M) guidelines, we now have data on how those revisions may have impacted actual E/M code selection by healthcare providers. Utilization of level 4 visits is up…
Details
February 25, 2022 | By Bryan Meek, Esq., Brennan, Manna, and Diamond The Department of Health and Human Services published three parts to the No Surprises Act towards the end of 2021, which took effect January 1, 2022. The Act is intended to protect consumers from “balance billing,” which occurs when a patient receives…
Details
February 25, 2022 | By J. Paul Spencer, CPC, COC As an auditor in the post-2021 E/M landscape, one of the more common questions I receive has to do with one of the bullet points found in the “Moderate” line of the new E/M grid labeled “Number and Complexity of Problems Addressed”. While this…
Details