September 23, 2022 | By Sonal Patel, CPMA, CPC, CMC, ICDCM Can I be honest here? I am thrilled that I am finished with the 1995 and 1997 (“95 and 97”) evaluation and management (“E/M”) guidelines for office and outpatient visits. Okay, okay, obviously I am not serious, but I am happy seeing that…
September 16, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Audits are nothing new but the requirements tied to them are in a lot of cases. For years I have talked about and encouraged clients to create Corrective Action Plans (CAPS) when they uncover something that requires adjustments and possibly…
August 19, 2022 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT Training techniques used from the 2021 Documentation Guidelines training and implementation may be helpful with training for these updates as well, even though these updates relate to different types and places of service. However, a lesson learned from 2021 was that education,…
Strategic Litigation Services | CEMA Certification | Audit Services Details of the Case From Expert Witness Sean M. Weiss Recently, Sean M. Weiss with NAMAS’ parent company DoctorsManagement testified as an expert witness in a federal court case against four healthcare providers in one of the largest Medicare/Medicaid fraud cases in U.S. history. Read below as Sean recaps…
You know, sometimes, as coders and auditors, we’re the last ones to know about new things that come into the office, but sometimes we should be the first. This past week I got an e-mail from a friend (who is also a client and NAMAS member) who said their office received a new type of…
August 12, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Self-audits are critical. They demonstrate compliance, or at least a “good-faith effort” to be compliant; they minimize refunds of overpayments to “actuals” and also mitigate the potential for a multiple being added. Most importantly, they prevent an auditor, agent, or…
August 5, 2022 | By Michele Strickland, CPC, CEMA Incident-To is often discussed in coding and compliance circles, but when reviewing encounters, I routinely find the criteria fails to meet or support the billing of non-physician practitioners (NPPs) and/or other clinical staff (auxiliary). There are two types of Incident-To services; a component of the service…
April 22, 2022 | By Grant Huang, CPMA, CPC You’ve taken the time to complete a painstaking audit of a provider, combing through their documentation on an EHR or maybe even navigating through a handful of handwritten notes. You’ve calculated their score – it doesn’t look too good – and now it’s time for…
The 2023 AMA documentation guidelines hit us on June 30th -and I’ve had a chance to read through them. I want to remind you that while we have the AMA changes, we don’t yet have the final rule from CMS. We don’t know how CMS is going to process all of these changes. As you’re…
July 8, 2022 | By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM According to the U.S. Department of Health and Human Services (HHS) and the Office of Inspector General website, things have changed in regard to the controversial question of mandatory compliance plans. The Federal Register…