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, one…
December 9, 2022 | By Rachel Rose, JD, MBA Overview Although it is said that “business is global”, there are some nuances to this blanket statement to consider when creating, receiving, maintaining, or transmitting electronic protected health information or electronic health information (herein the blanket term “PHI” is used) internationally.[i] Before delving into items…
November 18, 2022 | By Rhonda Buckholtz, Owner, Coding and Reimbursement Experts Determining risk is important for having an effective compliance program. Policies need to be developed to your specific needs. Depending on your specialty, your geographic area, your risk areas, etc. For example, yours might be diagnostic testing, modifiers, emergency evacuations, ASC rules,…
Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM Incident to a physician’s professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness.…
October 14, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Why is it that payors often, can’t or won’t comply with their own reimbursement rules or guidelines for processing/adjudicating claims? Some (who are contracted to The Centers for Medicare and Medicaid Services (CMS)) may view this blog in a negative…
Have you given much thought to an encounter that you might review that actually has CPT or ICD-9 codes documented or included right in the EMR-produced note? (Yes, I do start off many conversations just that way. To be in my head… it’s a scary thing!) So, here’s my question to you: What happens when…