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…
Navigating Prescription Drug Medical Weight Loss Stephanie Allard, CPC, CEMA, CPA-RA, RHIT August 23, 2024 This year, a recurring issue is continuing to pop up in the audit reviews that I am completing for clients. The issue is related to medical weight loss and what I think is a complete misunderstanding in the industry regarding…
Appreciating Informed Consent in the Context of False Claims Act Liability. Rachel V. Rose, JD, MBA[A] August 16, 2024 Overview A recent settlement by the U.S. Department of Justice (DOJ) in a False Claims Act (FCA) case underscores the importance of adequate informed consent for a variety of reasons. First, it is mandated by federal…
Balancing Compliance Costs and Benefits Gene Good, JD, CPA | CEO, DoctorsManagement, LLC August 9, 2024 Some points to consider when setting your payor Compliance budget and how to show the return on your compliance investment. Whether you are a physician’s office or health system, there is ongoing pressure on margins and increasing recoupment activity…
June 21, 2024 By: Katie McGonigal, JD Associate Management Consultant , DoctorsManagement, LLC In an increasingly online world where credit cards and digital wallets are quickly becoming the norm, the concept of a cash-pay medical practice may seem foreign to some. This week’s tip explores the pros and cons of accepting cash versus credit cards.…
June 7, 2024 | By: Bridget Smudrick, BS, MLS(ASCP) | Director of CLIA Compliance Where CLIA compliance is concerned, documentation is key. CLIA stands for the Clinical Laboratory Improvement Amendment. This set of federal regulations established in 1988 governs how patient testing is performed in the clinical laboratory setting. These regulations ensure the accuracy of…
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…