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,…
Details
I would like to make things right the first time so often, that they have errors and I need to make corrections -and the same is true for providers. In this post, I would like to approach the topic of addendums. The thing about addendums is… there are no clear-cut rules – except how to…
Details
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
Details
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,…
Details
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…
Details
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…
Details
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…
Details
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…
Details
You know, those conversations you have between another coder and auditor or better yet, those difficult conversations with a physician about the mechanics of the code vs. the intent of the code? That’s what I want to discuss today. Sometimes this gets lost and it gets the better of us as a coder and/or auditor.…
Details
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