THE RECAP An announcement on Monday, January 30th, by the OMB (Office of Management and Budget), and the White House, stated that they plan to end the COVID-19 national emergency and public health emergency on May 11th. The end of the emergency declarations would signal a new chapter in the Biden administration’s response to the…
January 13, 2023 | By J. Paul Spencer, CPC, COC A major change to appeals submissions is set to begin on February 1st, 2023 that will effect practices and facilities across the country. United Healthcare (UHC) is mandating the submission of electronic reconsiderations and appeals for most types of claims and plans under their…
Today’s Take is about independent interpretation, and I know we’ve talked about this before, but I think this is one we’ll have to discuss a lot. Recently I got a question about this topic from Tracy (Hi Tracy! I’m glad to answer your question.) So, Tracy explained that her providers are pain management providers and…
January 13, 2023 | By J. Paul Spencer, CPC, COC I received a great question the other day, and I thought it was a great stepping-off point for a discussion in this space. It’s 2023, and a patient is placed in observation status by an admitting physician. A non-admitting physician is called in for…
How many charts have you guys already audited in 2023? That’s a really big question. I hope you’re already starting to discuss your audit plan for 2023. It’s not too early, and I hope you’ve already started actually auditing charts for 2023. I recently sent out an audit tip that addressed productivity and quality production…
January 6, 2022 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT Leaning into a new year, as I sit to write this audit tip, I am reflecting on questions that we have been asked throughout 2022 and wondering if any of these might help everyone launch a new year with greater perspective. Well,…
You know, those conversations you have between another coder and auditor or better yet, those difficult conversations with a physician about the mechanics of the code vs. the intent of the code? That’s what I want to discuss today. Sometimes this gets lost and it gets the better of us as a coder and/or auditor.…
I would like to make things right the first time so often, that they have errors and I need to make corrections -and the same is true for providers. In this post, I would like to approach the topic of addendums. The thing about addendums is… there are no clear-cut rules – except how to…
Have you ever had one of those questions that you think you have the answer to, but the more you read it, the more you’re swayed the other way — and then you read it again and you have an even different answer? Well, one of our NAMAS members (and a friend of mine) emailed…
When you’re providing audit feedback or education for providers, have you been receiving pushback or comments from providers regarding qualification time statements? When we think about the qualification statement that is required, well…best practices, for our time-based E&M services, those qualification statements are really needed in order to qualify the amount of time that our…