Top 10 Compliance Pitfalls When Completing the CMS-1500 Form (And How to Avoid Them) Written by: Beth Schleeper The CMS-1500 form is one of the most widely used claim forms in healthcare for submitting insurance claims for professional services. While it is a vital tool for reimbursement, there are several compliance pitfalls that healthcare providers…
The Auditor’s Role in Appeals: A Key Player in the Compliance Process Written by: Betty Hovey, BSHAM CCS-P CDIP CPC COC CPMA CPCD CPB CPCI The appeals process is a critical component of health care compliance, ensuring that denied claims are appropriately challenged and reconsidered. When providers and health care organizations receive claim denials, they…
December 06, 2024 | By Pam Warren, MHA, COC, CPC, Fellow It is very important to healthcare providers and leaders that the work auditors perform, the results auditors report and the recommendations auditors make are valid. An auditor’s reputation is dependent upon audits that are legitimately performed and accurately reported. If audits are perceived…
December 13, 2024 | By Rhonda Granja, B.S., CMA, CPC, RMC, CMC, CMOM, CMIS As we navigate this complex world of coding, every year we prepare for changes, updates, new codes as well as deletion of codes. For 2025, there are 420 overall updates that are in the CPT 2025 code set. Those include…
July 26, 2024 By:Pamela Warren, MHA, COC, PCS, CPC, Fellow Auditing Surgical Services While E&M auditing continues to be the industry favorite for professional medical auditors in this field, there are several reasons and opportunities to audit surgical services. However, even though many surgeons spend a fair amount of office time in consultation with…