Here’s Your Sign… Shannon O. DeConda, CPC, CPMA, CEMA, CPA-EDU August 30, 2024 I recently visited a new provider’s office and noticed two prominent signs posted everywhere—one about a $100 no-show fee and another offering B-12 shots for cash. Surprisingly, the compliance issue isn’t with the no-show fee but with the B-12 cash service. Let’s…
Navigating Prescription Drug Medical Weight Loss Stephanie Allard, CPC, CEMA, CPA-RA, RHIT August 23, 2024 This year, a recurring issue is continuing to pop up in the audit reviews that I am completing for clients. The issue is related to medical weight loss and what I think is a complete misunderstanding in the industry regarding…
April 5, 2024 | By: Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM (updated 4/6/2024) 2024 brought new HCPCS codes that Medicare, Medicare Advantage and some 3rd-party Commercial plans that they will now pay for. One of those codes is the G0136; that is the Social Determinate…
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,…
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,…