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…
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…
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,…
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…
February 4, 2022 | By Scott Kraft, CPMA, CPC Medicare is making big changes to its policies for billing split/shared visits. While the main policy shifts take place in 2023, there are important changes to the rules for split/shared services in 2022 that must be followed for these services to be covered and billable…
February 1, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC As 2022 kicks into full gear one of the biggest areas providers (*rendering services in hospitals) face a change is tied to the 2022 CMS Split/Shared Visit Rules and what the anticipated impact(s) will be (here is a link…
December 17, 2021 | By Stephanie Moore, CPC, CPMA Many facilities will require a preoperative history and physical within 30 days of a procedure. Does this requirement from the facility support the medical necessity of an E/M visit? The answer is maybe. Medicare transmittal 1719 states, ”For purposes of billing under the Physician Fee…
December 10, 2021 | by Kelley Chappell Larkins, CPMA, CPC Are you ever tempted to just sweep those small claim denials under the rug? Do you sometimes wonder if it is worth the time and effort to figure out why a code, which will end up yielding $30, is being denied? Does it feel…
December 3, 2020 | By Holly Cassano, CPC, CRC There are not many positives that are generally born out of a Pandemic, but for the COVID 19 Pandemic, there have been a few and one of them is the creation of the HRSA Uninsured Portal. I call it a provider “Godsend” as it has…