When to Negotiate Insurance Contracts
September 3, 2021 | By Melody Irvine, CPC, CPMA, CEMC, CFPC, CPB, CPC-I, CCS-P, CMRS, CMRS, CMCS Often physicians’ groups sign insurance contracts without analyzing or performing an in-depth…
When Consult Documentation is Undone by the Clinician’s Own Documentation
July 30, 2021 | By Scott Kraft, Auditing Specialist, DoctorsManagement While payers have increasingly turned away from covering consultation services, this type of billing is not extinct yet. Consultations…
Shared Visits
July 16, 2021 | By David Glaser On May 3rd CMS pulled the shared visit language from the Manuals. The government has increasingly recognized that only statutes and regulations can…
The Year of the Audit: Stand Your Ground with Payers
January 22, 2021 | By Sean M. Weiss, CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC Welcome to 2021, “y’all” – as we say down yonder in the beautiful South!…
Better late than never: Stimulus bill salves pain of conversion factor cut, also delays G2211
January 7, 2021 | By Grant Huang, CPC, CPMA The 2021 Physician Fee Schedule (PFS) had included the largest one-year reduction to the Medicare conversion factor (CF) in more than…
Changes to Stark May Require Tweaks to the Physician Compensation Formula
January 8, 2021 | By David Glaser In early December, the Centers for Medicare and Medicaid Services (CMS) issued new rules that dramatically revise the Physician Self-Referral Law, commonly…
After the Fire: Consideration of Risk-Based Contracts Post-COVID-19
December 18, 2020 | By Paul Spencer, CPC, COC “Risk adjustment,” as defined by CMS, is a method by which Medicare Advantage plans are compensated for demonstrating that the…
Finally: CMS releases 2021 final rule; no major surprises seen
December 15, 2020 | By By Grant Huang, CPC, CPMA At long last, CMS has published its Medicare Physician Fee Schedule (PFS) final rule, and while some of the…
Insurance Coverage for COVID-19 Testing
November 13, 2020 | By Bryan Meek, Esq., Brennan, Manna, and Diamond As the COVID-19 pandemic continues to wreak havoc globally, routine COVID-19 testing of employees, patients, and the…
Focus Providers on Clinically Relevant History and Exam, and Concise Medical Decision Making
October 16, 2020 | By Scott Kraft, CPMA, CPC It’s fair to say the 2021 changes to the E/M documentation guidelines ease the documentation burden on the rendering provider…