Navigating E/M Reporting: Time-Based Billing and Separately Reported Services

March 29, 2024 | By: Teresa Schrage, RDCS, RVT, CPC, CPMA Reporting an E/M with separately reported services continues to be a topic of discussion amongst coders, auditors, and providers. First, let’s review what a significant, separately reported E/M is and what identifies the service. An E/M is significant and separately identifiable from a procedure/service…

Supervision of Ancillary Staff

April 26, 2024 | Sean M. Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC  The perennial inquiry into the scope of services that nurses and ancillary support staff may offer under physician supervision remains a frequent topic of discussion. Furthermore, I frequently encounter situations where the concept of “incident-to” care is central to the controversy.…

Break a Leg! Audit Hazards in Orthopedic Medicine

March 15, 2024 | By Sonal Patel, BA, CPMA, CPC, CMC | CEO & Principal Strategist at SP Collaborative, LLC Introduction Did you know that under-documenting poses an audit hazard for any specialty provider? This is not spoken about too loudly by payors since their primary focus is identifying overpayments, rather than underpayments. Nevertheless, I…

Evaluation and Management Services: Beyond Box Checking

February 16, 2024 | By Jennifer McNamara, CCS, CPC, CDEO, CPMA, CRC, COSC, CGSC, COPC, AAPC Approved Instructor | CEO, Healthcare Inspired, LLC Beyond Box Checking Compliance with reporting Evaluation and Management (E/M) services often takes center stage and has received much attention in recent years. They are the main revenue stream for Primary Care…

Navigating the Importance of the Diagnosis in the Audit Landscape

January 12, 2024 | Kimberly Jolivette Williams, CPC, CPB, CPMA, CPC-I, CANPC, CCC, CEMC Navigating the Importance of the Diagnosis in the Audit Landscape: In our complex and evolving healthcare business landscape, where financial integrity and regulatory compliance are paramount, medical audits stand as a critical tool for safeguarding the fiscal health of medical practices and…

Do Claim Denials and Offsets Fail To Align With Claims Handling Compliance Requirements?

January 26, 2024 | By: Karlene Dittrich, CBCS, CPC, CPMA, CECCS | Certified ERISA/PPACA Claims Handling Compliance & Appeal Specialist The most common question I am asked in my seminars sharing relevant laws that support claims handling compliance requirements is: “But what about my contract?”  Insurance companies write payer contracts in a way that leaves…