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…
January 5, 2024 | By Victoria Moll, CPC, COC, CPMA, CRC, CPFC, CPRC, AAPC Approved Instructor, Fellow CEO, Contempo Coding The strategic use of Modifier 25, particularly when dealing with same-day procedures within global periods, is essential. Throughout my career, I’ve seen multiple colleagues working on claim edits and would cheerfully apply whatever modifier the…
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,…
Amy C. Pritchett, CCS, CRC, CPA-RA, CPC, CPMA, CPCO, CDEI, CDEO, CDEC, CANPC, CASCC, CMPM Manager, HCC Coding/Audit & Education Services, Pinnacle Enterprise Risk Consulting Services AAPC Fellow |Approved Instructor |ICD-10-CM/PCS Trainer On March 31, 2023, the Centers for Medicare and Medicaid Services (CMS) released the CY 2024 Medicare Advantage (MA) Capitation Rates along…
October 3, 2023 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT Have you seen the new AMA Smart Brief on Modifier 25 that was released on August 17th? That’s what I want to talk to you about today. I want to break down the information because I specifically noticed there is a stark…