January 13, 2023 | By J. Paul Spencer, CPC, COC A major change to appeals submissions is set to begin on February 1st, 2023 that will effect practices and facilities across the country. United Healthcare (UHC) is mandating the submission of electronic reconsiderations and appeals for most types of claims and plans under their…
In Today’s Take, let’s discuss the difference between preventive care. You might be thinking this is “101”. But it really isn’t. Oftentimes, when conducting chart audits, we not only we see issues with a lack of documentation criteria, especially with Medicare preventive services, but we also see confusion regarding the lack of interpretation about what…
Have you given much thought to an encounter that you might review that actually has CPT or ICD-9 codes documented or included right in the EMR-produced note? (Yes, I do start off many conversations just that way. To be in my head… it’s a scary thing!) So, here’s my question to you: What happens when…
October 14, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Why is it that payors often, can’t or won’t comply with their own reimbursement rules or guidelines for processing/adjudicating claims? Some (who are contracted to The Centers for Medicare and Medicaid Services (CMS)) may view this blog in a negative…
September 30, 2022 | By Christine Hall, Senior Consultant, CHC, CPC, CPB, CPMA, CRC, CEMC, CPC-I Certified Instructor Coordination of benefits can be described as when two or more insurance plans work together to determine the order of coverage liability. This coordination between plans exists to avoid duplicate payment, which could result in…
September 2, 2022 | By Bryan Meek, Esq., Brennan, Manna, and Diamond Patients missing their healthcare appointments without adequate notice can cost practices a lot of money, as well as deprive patients of necessary care. While one solution to mitigate this damage is to charge patients for missed appointments, policies should be written…
August 12, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Self-audits are critical. They demonstrate compliance, or at least a “good-faith effort” to be compliant; they minimize refunds of overpayments to “actuals” and also mitigate the potential for a multiple being added. Most importantly, they prevent an auditor, agent, or…
July 1, 2022 | By Stephanie Allard, CPC, CEMA, RHIT After all the hype surrounding the upcoming Cigna policy regarding modifier 25 and pre-bill reviews, it seems as if Cigna is not planning on implementing the policy as planned on August 14, 2022. At the time I am writing this, there is recent news…
June 17, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC I am constantly being asked what can be done when government and commercial payors are slow-walking claims for payment. The simple answer is to know your state and federal law. First, let’s tackle the federal law which is 42 CFR…
An ortho client emailed an interesting question this past week that is a good one to think through. For post-op major joint replacement patients, they would like to send their RN to the patient’s home for follow-up check-in visits. They wanted to provide this as an optional cash pay service. As a compliance forward auditor,…