Insurance Discrimination – Against the Provider Author: Jeana M. Singleton, Esq. When the concept of “insurance discrimination” rears its ugly head, we often think of it in the context of when an insurance company treats some people differently than others based on protected classes, such as race, national origin, sex, or religion. Sometimes, this type…
Understanding Independent Interpretation in E/M Coding: Three Essential Requirements Shannon O. DeConda, CPC, CPMA, CEMA, CPA-EDU October 4, 2024 In the realm of Evaluation and Management (E/M) coding, independent interpretation is an often misunderstood component of the Medical Decision Making (MDM) table. Proper documentation of independent interpretation is required to impact the MDM and, consequently,…
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…
June 14, 2024 | By: Jodi Beebe, CPC, COBGC, CPMA, CPB One physician’s group quest for revenue cycle greatness… As payer rules and edits become increasingly strict, finding ways to improve coding accuracy and foster a corporate culture of compliance is crucial. A significant return on investment exists for maintaining an excellent revenue cycle within any…
May 24, 2024 | By: Lindsey Chatelain, CPC, CRC If you have ever been the subject of a payer audit, you know it can be daunting. Not only does it delay payment and increase the number of records requests your staff has to process, but getting off the audit is also difficult. It is achieved only…
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…
March 22, 2024 | By Carol Ittig, MBA, CMPE Introduction: In the fast-paced world of healthcare billing, clean claims are the key to maximizing revenue and minimizing headaches. A significant contributor to claim denials is inaccurate patient eligibility information. This article explores a multi-step approach to patient eligibility verification, empowering your team to submit clean…
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…
February 2, 2024 | By Christine Hall, Senior Consultant, CHC, CPC, CPB, CPMA, CRC, CEMC, CPC-I Certified Instructor Navigating Healthcare Claims and Audits for Purchased Diagnostic Testing: In the complex world of healthcare, accurate reporting of services is crucial for ensuring quality patient care and fair compensation for medical providers. One significant aspect of this…
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…