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…
Insurance Discrimination – Against the Provider Author: Jeana M. Singleton, Esq. When the concept of “insurance discrimination” rears its ugly head, we often think of it in the context of when an insurance company treats some people differently than others based on protected classes, such as race, national origin, sex, or religion. Sometimes, this type…
Understanding Independent Interpretation in E/M Coding: Three Essential Requirements Shannon O. DeConda, CPC, CPMA, CEMA, CPA-EDU October 4, 2024 In the realm of Evaluation and Management (E/M) coding, independent interpretation is an often misunderstood component of the Medical Decision Making (MDM) table. Proper documentation of independent interpretation is required to impact the MDM and, consequently,…
Here’s Your Sign… Shannon O. DeConda, CPC, CPMA, CEMA, CPA-EDU August 30, 2024 I recently visited a new provider’s office and noticed two prominent signs posted everywhere—one about a $100 no-show fee and another offering B-12 shots for cash. Surprisingly, the compliance issue isn’t with the no-show fee but with the B-12 cash service. Let’s…
Preventative Testing – Unique Risk Stories – Listening to your patients By Jill Young CEMC, CPC, CEDC, CIMC September 27, 2024 I am going to tell you a story about my family and their journey with Preventive Testing and colon cancer. Names have been changed to protect the innocent and some facts may have been…
Getting it right: HCC in Primary Care Rhonda Buckholtz CPC, CPMA, CDEO, CRC, CHC, COPC September 20, 2024 Many of us have a love/hate relationship depending on your role in healthcare. From a provider standpoint, most often we think of these as an administrative burden with no upside. However, a shift in thinking is needed…
The Well Woman Exam Crystal Tompkins CDEO, CPMA, CPC, CRC, COBGC, and Educator and Auditor September 13, 2024 I will never forget the wonder of being asked to write an article for NAMAS. The nerd in me was ecstatic, and the auditor/coder in me was completely in shock. After that feeling subsided, reality quickly set…
Safeguarding Medical Necessity in Non-face-to-face Exchanges Anna McGregor CLP, CPC, CPCO, CPMA, CPA-RA, CEMC, CEMA September 6, 2024 Has there been a moment when auditing an encounter when one wondered if this service was necessary because a reasonable indication for medical services was not identified? Should medical necessity be identified as the appropriateness of a non-face-to-face…
Navigating Prescription Drug Medical Weight Loss Stephanie Allard, CPC, CEMA, CPA-RA, RHIT August 23, 2024 This year, a recurring issue is continuing to pop up in the audit reviews that I am completing for clients. The issue is related to medical weight loss and what I think is a complete misunderstanding in the industry regarding…
Appreciating Informed Consent in the Context of False Claims Act Liability. Rachel V. Rose, JD, MBA[A] August 16, 2024 Overview A recent settlement by the U.S. Department of Justice (DOJ) in a False Claims Act (FCA) case underscores the importance of adequate informed consent for a variety of reasons. First, it is mandated by federal…