May 20, 2022 | By Toni Elhoms, CCS, CPC, CPMA, CRC I know I am not the only one who is completely appalled by the recent bombshell story on Cigna’s shady claims adjudication practices. ProPublica recently published a scathing article that pulls back the curtain on “PXDX” – a cost-containment strategy deployed by Cigna…
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,…
January 7, 2022 | By Toni Elhoms, CCS, CPC, CPMA, CRC It’s our favorite time of the year again – coding and regulatory compliance update season! As I’m sure many of my compliance colleagues can relate, this is the time of the year when we get inundated with “Can I pick your brain” requests…
November 26, 2021 | By Toni Elhoms, CCS, CPC, CPMA, CRC As I am sure many of my colleagues can relate, I have frequently heard statements like, “All my E/M services are coded based on time because it’s just easier” or “I add total time to all my notes just to cover my bases”.…