Navigating the Importance of the Diagnosis in the Audit Landscape

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…

Do Claim Denials and Offsets Fail To Align With Claims Handling Compliance Requirements?

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…

Modifier 25: Optimizing E&M and Same-Day Procedure Coding

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…

Pre-Op Visits vs. Pre-Op Clearance Visits: Which are Billable?

  August 11, 2023 | By Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM | Terry Fletcher Consulting, Inc. | Healthcare Coding and Reimbursement Consultant, Educator and Auditor | Podcast Host, CodeCast®, NSCHBC Edge Podcast, #TerryTuesday TCG Podcast | NAMAS Educational Speaker and Writer A question comes up often regarding…