Understanding Chronic and Principal Care Management Services (CCM vs. PCM)

  September 29, 2023 | By Grant Huang, CPMA, CPC If you’ve never heard of principal care management (PCM) or chronic care management (CCM) services before, you’re not alone. Medicare introduced these new benefits for Part B beneficiaries in 2021 and 2022, respectively, but the agency’s own utilization data shows that adoption has been fairly…

Break a Leg! Audit Hazards in Orthopedic Medicine

March 15, 2024 | By Sonal Patel, BA, CPMA, CPC, CMC | CEO & Principal Strategist at SP Collaborative, LLC Introduction Did you know that under-documenting poses an audit hazard for any specialty provider? This is not spoken about too loudly by payors since their primary focus is identifying overpayments, rather than underpayments. Nevertheless, I…

Evaluation and Management Services: Beyond Box Checking

February 16, 2024 | By Jennifer McNamara, CCS, CPC, CDEO, CPMA, CRC, COSC, CGSC, COPC, AAPC Approved Instructor | CEO, Healthcare Inspired, LLC Beyond Box Checking Compliance with reporting Evaluation and Management (E/M) services often takes center stage and has received much attention in recent years. They are the main revenue stream for Primary Care…

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…

A Three-Year Wait Ends but raises questions of simplicity versus complexity

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…

Problems Addressed During an Encounter

  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…