Overview of Hospice Care Additional Services (non-Hospice Organization) Medicare beneficiaries who have a terminal illness with a life expectancy of six months or less can elect to have their end-of-life care provided by a hospice organization (the “hospice”). Medicare then pays hospice to provide all the care that the patient needs that is related to […]
Transforming Patient Collections: Expert Insights and Strategies | Webinar
Recorded October 16th, 2024
Guest Presenter Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC
Gain valuable insights on how to effectively respond to industry changes and actionable steps to enhance your revenue cycle management. Join Elizabeth for an engaging and informative webinar centered around navigating the current inflection point in patient collections. Patient financial responsibility is increasing – and it’s time for you to rise to the challenge!
Compliance Guide
You may have heard about the “Seven Elements for an Effective Compliance Plan.” In fact, if you enter that term in a popular web browser “about 575,000” results appear within seconds. Fortunately, compliance and enforcement agencies endorse the elements and provide great examples on what to do – without having to delve much into those […]
Where Does it Say That? | Webinar
Recorded October 9th, 2024
Guest Presenter Pam Warren, MHA, COC, CPC, Fellow
This webinar is a guide for auditors and coders looking for regulatory guidance when they are answering coding, compliance and regulatory questions from practitioners and colleagues. This presentation offers common healthcare compliance scenarios and provides the location of the associated guidance.
Developing an Audit Work Plan to Satisfy Your Compliance Program | Webinar
Recorded September 25th, 2024
Guest Presenter Pam Warren, MHA, COC, CPC, Fellow
There are seven elements of an effective Compliance Plan per the OIG, and one of them is to conduct internal monitoring and auditing.
This presentation will give you some ideas on how to determine what content to audit, how to evaluate your risk, how to set up your audit process, and how best to report your results to your leaders.
OIG Report on Telehealth During the PHE
What? An OIG report without doom and gloom? Fire and brimstone? Slides In February, 2024 the OIG released an audit report of telehealth E/M services performed between March 2020 and November 2020. During this nine-month period practitioners submitted claims for 19 million E/M services. Before I talk about the report though, let me congratulate everyone […]
CMS Update on Medical Record Documentation for E/M Services
The world as we knew it Both the 1995 and 1997 evaluation and management (E/M) documentation guidelines stated that ancillary staff could record a review of systems (ROS), and past medical, family, and social history (PFSH) in a patient record. The billing physician/NP/PA needed to document that that information had been reviewed and verified. Only […]
Who is Responsible for Coding Physician Services? The Medical Provider or the Coder?
Legally, when a physician, physician assistant (PA) or nurse practitioner (NP) enroll in a Medicare, Medicaid or commercial insurance, the practitioner signs an agreement attesting that accurate claims will be submitted. Practitioners are responsible for claims submitted under their National Provider Identifier (NPI). CMS’s E/M guide says, When billing for a patient’s visit, choose codes […]
Billing Physician Services for Hospice Patients | Reference Sheet
Medical practices find the hospice modifiers confusing, and confusion leads to denials and payment delays. Use the decision trees below to help you determine if the service is separately billable once a patient has elected hospice and if so, how to bill it.
7 Sure Fire Ways to Owe the Government $4 million in Fines and Repayments | Coding Compliance
Most practices aren’t looking to pay the government any money in fines and repayment because of coding errors. Two recent OIG settlements described two practices that did just that. Most practices want to avoid this, of course, but some groups seem determined to achieve that outcome. In reviewing both of the settlements, there are some […]
This Practice Paid Medicare $4.48 Million
Do you sign up for email lists and then wonder why you did it? We all do, don’t we? But, one email I always read is from the Department of Justice that links to a description of actions, settlements and indictments related to health care billing and coding A few years ago, an Orthopedic practice […]
No Chart Left Behind: Deadline to Complete Medical Records
Years ago, I worked with a physician who was chronically behind in dictating his notes. The charts were crammed into boxes by date, lining the walls of his office. Sometimes, they flowed over into the hallway or into the break room. This caused major inconveniences when a patient called for a lab result or returned […]