Navigating the Complexities of Prolonged E/M Services
May 28, 2021 | Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content, innoviHealth Prolonged services codes were created to capture reimbursement for time spent with a…
Feds Moving Quickly Into Recoupment Audit Mode
May 7, 2021 | By Frank Cohen, Director of Analytics and Busines Intelligence It looks like the feds are moving quickly into recoupment audit mode in regards to telehealth…
COVID-19 Vaccine Coding
November 20, 2020 | By Brenda Edwards, CPC, CDEO, CPB, CPC-I, CEMC, CRC, CMRS, CMCS COVID-19 has been disrupting the healthcare environment for over a year now. Massive changes…
Auditing Critical Care Services
January 15, 2021 | By Stephanie Allard, CPC, CEMA, RHIT CMS defines critical care as “the direct delivery by a physician(s) of medical care for a critically ill or…
Better late than never: Stimulus bill salves pain of conversion factor cut, also delays G2211
January 7, 2021 | By Grant Huang, CPC, CPMA The 2021 Physician Fee Schedule (PFS) had included the largest one-year reduction to the Medicare conversion factor (CF) in more than…
Changes to Stark May Require Tweaks to the Physician Compensation Formula
January 8, 2021 | By David Glaser In early December, the Centers for Medicare and Medicaid Services (CMS) issued new rules that dramatically revise the Physician Self-Referral Law, commonly…
What You Need to Know About Prolonged Services in 2021
December 25, 2020 | By By Grant Huang, CPC, CPMA The New Year is nearly upon us and with it, implementation of the much-talked-about 2021 E/M guidelines for office/outpatient…
After the Fire: Consideration of Risk-Based Contracts Post-COVID-19
December 18, 2020 | By Paul Spencer, CPC, COC “Risk adjustment,” as defined by CMS, is a method by which Medicare Advantage plans are compensated for demonstrating that the…
Finally: CMS releases 2021 final rule; no major surprises seen
December 15, 2020 | By By Grant Huang, CPC, CPMA At long last, CMS has published its Medicare Physician Fee Schedule (PFS) final rule, and while some of the…
COVID-19: Resident Services Under the Medicare Primary Exception
November 27, 2020 | By Grant Huang, CPC, CPMA Auditing evaluation and management (E/M) services furnished by resident physicians under the Medicare Primary Exception (PCE) already required a firm…