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.…
May 3, 2024 | By J. Paul Spencer, CPC, COC Primary care providers are increasingly becoming gatekeepers to mental and behavioral health care. This is due partly to increased awareness in the medical field of the overall health effects brought about by mental illness, as well as the addition of CPT codes for reimbursement that…
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…
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…
February 16, 2024 | By Betty A. Hovey, BSHAM, CCS-P, CDIP, CPC, COC, CPMA, CPCD, CPB I have been in the healthcare field for more than 35 years, and remember when we didn’t have Evaluation and Management (E/M) codes. Then, we went through the 1995 and 1997 guidelines from CMS. All the elements, boxes, borders…
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…
January 19, 2024 | Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM As we all know, the PHE, public health emergency, ended on May 11th, but the confusion on how to report Telehealth services continues to live on. When Medicare published its Final Rule last November 2nd,…
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…
January 5, 2024 | By Victoria Moll, CPC, COC, CPMA, CRC, CPFC, CPRC, AAPC Approved Instructor, Fellow CEO, Contempo Coding The strategic use of Modifier 25, particularly when dealing with same-day procedures within global periods, is essential. Throughout my career, I’ve seen multiple colleagues working on claim edits and would cheerfully apply whatever modifier the…
December 29, 2023 | By Laidy Diana Martinez CPC, CPB, CPMA, CGSC, CGIC, CASCC January 2024 Marks the Arrival of G2211: A Three-Year Wait Ends but raises questions of simplicity versus complexity. Though G2211 isn’t a new concept, it has been on hold due to congressional decisions for the past three years. Finally, in January…