November 15, 2024 | By Scott Kraft, CPMA, CPC When I audit services performed in an infusion center, I’m addressing two key questions. First, were all of the patient’s infusion, injection, and/or hydration services documented appropriately for what is being billed? Second, if evaluation and management services were performed, were they medically necessary and…
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…
July 26, 2024 By:Pamela Warren, MHA, COC, PCS, CPC, Fellow Auditing Surgical Services While E&M auditing continues to be the industry favorite for professional medical auditors in this field, there are several reasons and opportunities to audit surgical services. However, even though many surgeons spend a fair amount of office time in consultation with…
July 19, 2024 Attestation Statements – Becoming the Expert By: Aimee Wilcox, CPMA, CCS-P Medical students become the proud owners of MDs once they have completed medical school; however, to become fully licensed practicing physicians, they must complete additional training. They are required to participate in a three to seven-year residency and fellowship program…
July 12, 2024 Auditing Complex Surgeries By: Jennifer McNamara, CPC,CCS,CRC,CPMA,CDEO,COSC,CGSC,COPC,CPC-I Medical Auditors are important members of the revenue cycle. They are responsible for monitoring coding and billing compliance and helping to reduce financial risk in healthcare organizations. Seasoned auditors will review highly complex services, such as surgeries performed on the spine. These surgeries require…
July 5, 2024 By: Mary A Curry, BS, CPC, CPMA Auditing the Global Package When auditing provider services, what is the best method to approach the concept of a global package? Some rental companies provide a renter with all-inclusive pricing for an apartment. The payment arrangement covers heating, electricity, water, and garbage for the…
June 28, 2024 By: Ashely Harless Biopsy vs Removal: A better understanding I was in an AAPC workshop with several doctors once, and when we reached integumentary day, biopsy vs. removal became a hot topic. The instructor knew I specialized in dermatologic coding and turned the conversation over to me. I was scared that I…
May 10, 2024 | By: LaDonna D. Brown CPC, CPMA, CEMA When I was asked if I would like to be a contributor to NAMAS May articles, my first thought was absolutely. This is particularly timely as May is Mental Health Awareness Month, a crucial period for coders and auditors to reflect on the importance…