Risk Adjustment (HCC) coding compliance is quickly becoming the forefront of primary care across the nation as value-based care models continue to be implemented within the healthcare industry. With the added administrative burden placed upon providers and...
The healthcare industry, and physician practices in particular, are experienced at weathering industry disruptors and a landscape that seems to be in perpetual change. However, the last few years have seen a notable increase in mergers and acquisitions, with all...
President Biden released his proposed FY2024 budget at the beginning of March. Though the budget must still clear the hurdle of Congressional approval, its final version is likely to have significant impact on health care organizations. The proposed changes cast a...
The following is a synopsis of the major changes to CPT that will take effect January 1, 2023.
In 2021, the American Medical Association implemented significant changes to the Evaluation and Management (E/M) code sets applicable in the office/outpatient setting. Those changes, which were intended to simplify coding by placing more emphasis on complexity and...
As we have seen since April 2021, we are still being influenced by the Great Resignation or the Big Quit. COVID-19 was a wake-up call for many people in general, but even more so for employees who were not satisfied with their current roles in the workplace. Employees...
The most recent significant changes to the E&M coding guidelines occurred in 2021 allowing physicians to choose between medical decision-making and time-based reporting for their services. Now, it appears we are in store for additional changes to begin January...
You’ve received a request for medical records from a payer, who is going to conduct an audit on your claims. Your Electronic Health Record (EHR) system is excellent, the notes are voluminous, your providers are well-versed at coding. If anything, you under code! You...
These are recaps of what they report as some of the trends and realities of compliance today
The innumerable horror stories related to payer audits have given rise to a new trend of undercoding, by intent! Many providers would rather be safe than sorry, all in the name of keeping their good names off the radar. However, undercoding can backfire, resulting in...