Auditing the AMA’s New Telemedicine Evaluation and Management (E/M) Codes: 98000–98016

Understanding New Audio-Only and Brief Telehealth E/M Codes: Documentation, Compliance, and Medicare Guidelines Written by: Gabriel Aponte Moberg The audio-only codes 98008 through 98015 require more than ten minutes of synchronous, real-time verbal communication. These services may be selected based on either total time or medical decision-making (MDM). Each code corresponds to specific MDM levels and…

Billing Battles: What to Do When Billing Instructions Don’t Add Up

Billing Compliance Conflict? Navigate It with Confidence Billing Instructions Raising Concerns? Here’s a Pro-Level Playbook Written by: Toni Elhoms   |   Alpha Coding Experts In the complicated world of pay-and-chase healthcare reimbursement, medical billing is not just a back-office support function, but rather a regulatory landmine for healthcare organizations! From Stark Law to the False Claims Act…

Ancillary Staff vs. Reimbursable Providers: Navigating CMS and Commercial Payor Rules

Are You Billing Ancillary Staff Correctly? Avoid Costly Errors Ancillary or Reimbursable? Why the Distinction Matters More Than Ever Written by: Sean Weiss   |   DoctorsManagement, LLC One of the biggest issues I address weekly for clients and law firms across the country is the use of “ancillary staff” vs. “reimbursable providers”. In the current environment, ensuring…

Why Medical Claims Auditors Should Embrace Autonomy for Non-Physician Qualified Providers

Why Medical Claims Auditors Should Embrace Autonomy for Non-Physician Qualified Providers  Embracing Provider Autonomy: A Smarter Approach to Medical Claims Auditing Written by: Jeana M. Singleton, Esq.   |   Brennan, Manna & Diamond, LLC  As the U.S. healthcare landscape continues to evolve, so too must the perspectives of those who safeguard its financial integrity, including those working…

CCM Under the Microscope: Are Your Providers Documentation-Ready?

CCM Under the Microscope: Are Your Providers Documentation-Ready?  Written by: Christine Hall, CHC, CPC , CDEO, CPB, CPMA, CRC, CEMC, CPC-I Chronic Care Management (CCM) services are getting extra attention from Medicare Administrative Contractors (MACs) as part of their Target, Probe, and Educate (TPE) program. They are closely reviewing CCM claims for possible misuse, which…