September 22, 2023 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT Let’s get uncomfortably honest. With continued reimbursement cuts, like this year’s $9-12k per provider E/M cut, organizations cannot sustain 100% coding validation. Now, let’s get brutally honest. This is compounded by a lack of truly skilled and knowledgeable coders looking to fill the…
Do you often bill the code 99211? I must admit, this is a service code that isn’t used much anymore, but it can be an excellent code to bill for the overhead when using our office staff. Let’s start with the Par Agreement entered into with your chosen insurance providers. This agreement states that claims…
September 15, 2023 | By: Edward Baker, Of Counsel | Lieff Cabraser Heimann & Bernstein If you lie awake at night worrying about whether your coding, auditing, or compliance practices might be based on misinterpretations of federal law, opening up your healthcare employer—or yourself!—to treble damages and penalties under the False Claims Act (FCA), you may…
You may have seen a couple of recent Documentation and Compliance Tips published on the NAMAS blog authored by health law attorneys who have had some opinions regarding Incident To and Shared Visits in the office/clinic space. These opinions do somewhat contradict how we have taught Incident To service and Split Shared service in place…
March 24, 2023 | By Jennifer McNamara, CCS, CPC, CDEO, CPMA, CRC, COSC, CGSC, COPC, AAPC Approved Instructor | CEO, Healthcare Inspired, LLC One modifier that often raises eyebrows and questions is Modifier 62. This modifier can impact reimbursement and compliance, making it a focal point for audits by the Office of Inspector General…
August 18, 2023 | By Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM | Terry Fletcher Consulting, Inc. | Healthcare Coding and Reimbursement Consultant, Educator and Auditor | Podcast Host, CodeCast®, NSCHBC Edge Podcast, #TerryTuesday TCG Podcast | NAMAS Educational Speaker and Writer As we all know the…
August 11, 2023 | By Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM | Terry Fletcher Consulting, Inc. | Healthcare Coding and Reimbursement Consultant, Educator and Auditor | Podcast Host, CodeCast®, NSCHBC Edge Podcast, #TerryTuesday TCG Podcast | NAMAS Educational Speaker and Writer A question comes up often regarding…
One of the amazing benefits of a NAMAS membership is “Ask The Expert”. For this “Take”, I’m going to share one of the questions submitted to us by a NAMAS member, Carol, about emergency room leveling related around chest pain and high complexity. So, Carol writes that the data column for most of their patients…
July 28, 2023 | By Jill Young, CPC, CEDC, CIMC I have been a consultant for over 20 years and have worked in the medical field for over 40 years. When I first was in a position that required me to research the rules and policies of both documentation and compliance issues, there was…
July 21, 2023 | By Scott Kraft, CPMA, CPC Whenever I audit charts under the 2021 E/M Documentation Guidelines, which now apply in all places of service, I like to start by reviewing the first and third columns. The first column is Number and Complexity of the Presenting Problem, and the third column is…