I know this is a loaded question. Unfortunately, for some it is a harsh reality. While we all agree that coding can be subjective, there are those times when the rules, and guidelines are clear. I have seen these misguided errors come back to bite providers far too often. It is critical to know exactly what codes are appropriate to submit for the services/supplies you are providing. Some services and supplies do not have an exact matching description, and this can cause confu

I'm a true believer and a big advocate of this saying. My Mother would say this to us frequently when we were growing up. Usually right after dinner when it was time to clean the table and do the dishes! We were a family of nine so she was so right. I'll wash, and you dry she would say... It was a lesson well learned early on in life. If we offer a service that can help you mitigate risk and make a difference in your practice or organization ( big or small), pick up the phone

I am posting these tips (with my compliance hat on), based on 35 years of boots on the ground experience. Some of my recommendations might seem like common sense, but you would be surprised to know just how real and common these issues are.

here are so many factors to consider when billing for healthcare services today. Yes, documentation and coding compliance is a must. However, if you do not follow appropriate billing practices as well, you might end up with a hefty over-payment recovery demand, or worse. It is a providers responsibility to understand what is in their agreement, and to follow payer policies. It is a great idea to have these agreements reviewed prior to signing them. Knowing the requirements of

Happy Monday! Here is one more topic to stir the pot. This case is a few months old however, awareness is still very much needed. https://lnkd.in/e5BPgTa https://lnkd.in/eP3--nT

"The best leaders are humble enough to realize their victories depend upon their people." John C. Maxwell

No one else will ever invest in you, the way that you will. No one can take away your knowledge, integrity, and passion. I think these 3 key ingredients make up the "secret sauce" in all of us. There is no limit on what we can accomplish in life as long as we believe in ourselves and are good to others. Today's tip is about being mindful to make time to continue investing in, and elevating yourself, and those around you. I make sure I set aside time to visit my list of "bookm

Even though Evaluation & Management codes are not technically considered "time based", payers, and enforcers calculate the "typical time" attached to the codes to mine for providers who bill for "impossible days". These cases are defensible however, not cheap or painless. If you are not sure what your billing productivity benchmark is, ask your revenue cycle team for a report. Learn how to query, and mine your own data, because guaranteed someone else is already doing it.

This week we are hoping to set aside the "don'ts", and "stop that's" and focus on what you should, and can do to reduce risk in your organizations. Effective compliance programs include several key elements that are considered to be "controls". A few of those core controls include; policies and procedures, training & education, and auditing & monitoring. While they are all essential, the most "important" control of these three is, auditing. Q: Why is auditing the most importa

This weeks tips are all about "doing". The link below will take you to the NYS OMIG website compliance page. It is here that you can learn if you meet the criteria for mandatory compliance program adoption, and certification. https://lnkd.in/e-NVwgh Medicaid Managed Care plan earnings and orders also qualify as "indirect income" so be sure to include it. If you are a medical billing company, the claim submission value is cumulative for all claims submitted.