January 12, 2024 | Kimberly Jolivette Williams, CPC, CPB, CPMA, CPC-I, CANPC, CCC, CEMC Navigating the Importance of the Diagnosis in the Audit Landscape: In our complex and evolving healthcare business landscape, where financial integrity and regulatory compliance are paramount, medical audits stand as a critical tool for safeguarding the fiscal health of medical practices and…
January 19, 2024 | Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM As we all know, the PHE, public health emergency, ended on May 11th, but the confusion on how to report Telehealth services continues to live on. When Medicare published its Final Rule last November 2nd,…
January 26, 2024 | By: Karlene Dittrich, CBCS, CPC, CPMA, CECCS | Certified ERISA/PPACA Claims Handling Compliance & Appeal Specialist The most common question I am asked in my seminars sharing relevant laws that support claims handling compliance requirements is: “But what about my contract?” Insurance companies write payer contracts in a way that leaves…
January 5, 2024 | By Victoria Moll, CPC, COC, CPMA, CRC, CPFC, CPRC, AAPC Approved Instructor, Fellow CEO, Contempo Coding The strategic use of Modifier 25, particularly when dealing with same-day procedures within global periods, is essential. Throughout my career, I’ve seen multiple colleagues working on claim edits and would cheerfully apply whatever modifier the…
December 22, 2023 | By: Edward Baker, Of Counsel | Lieff Cabraser Heimann & Bernstein On September 30, 2023, the U.S. Department of Justice announced a $172 million False Claims Act (FCA) settlement with Cigna relating to the submission of invalid HCC diagnosis codes to CMS in order to increase Medicare Advantage member risk scores, and therefore,…
December 29, 2023 | By Laidy Diana Martinez CPC, CPB, CPMA, CGSC, CGIC, CASCC January 2024 Marks the Arrival of G2211: A Three-Year Wait Ends but raises questions of simplicity versus complexity. Though G2211 isn’t a new concept, it has been on hold due to congressional decisions for the past three years. Finally, in January…
December 15, 2023 | By Stephanie Allard, CPC, CEMA, RHIT One area that keeps coming up in my conversations and education sessions is the definition and understanding, or misunderstanding, of the concept of a “problem addressed” during an encounter and how that is applied to E/M services. As treating practitioners document and as we…
December 1, 2023 | By Natasha Timberlake, BSHCM, CRCR, CPC, CPB, COC, CRC, CPPM, CPMA, CHONC, AAPC Approved Instructor Reviewing the rules and guidelines regarding chemotherapy and therapeutic infusions and injections can be intimidating and confusing. Here are some helpful tips to help it become easier to understand. The first step is to review the…
December 8, 2023 | By Shannon O. DeConda The healthcare landscape is constantly evolving, and with dwindling reimbursement models, it is crucial to embrace innovative solutions for new healthcare delivery models to provide efficient and accessible services for patients. As we enter 2024, telehealth integration into medical practices has become necessary rather than convenient. As…
August 4, 2023 | By Bryan Meek, Esq., Brennan, Manna, and Diamond OVERVIEW: As telehealth has become more prominent across the country, providers have had the opportunity to practice across state lines more easily. However, most states require that providers be licensed in their state to provide care to residents in their state. Thus,…