Compliance: it’s a “dirty word” in Healthcare that haunts practice managers day-in and day-out as they try to avoid denials, audits, and recoupments. Achieving compliance is no small task given the complexity of payer requirements and ever-changing regulations. Employee burnout also makes it difficult to maintain compliance because when staff is burned out, as they’re […]
Terry’s Top Ten Tuesday focus this month is on breaking healthcare news. From PHE being extended at the last minute, to CMS audits starting in a week, and HHS plans for payment parity across the OPPS to the physician reimbursement platform, not one stone is left unturned in the latest CodeCast. Subscribe and Listen You […]
Now that most states are experiencing a surge of COVID-19 cases, many states are also on the verge of a second lockdown as well. Terry Fletcher helps guide you in getting back to basics in the latest episode of the CodeCast podcast. It is time to take inventory of some of the ways our practices […]
Medical Decision Making specifically refers to the complexity of establishing a diagnosis and/or selecting a management option. Medical necessity refers to the appropriateness of the service provided for a certain condition. Problems can arise with training and documentation, when MDM and medical necessity are used interchangeably, or when practices and payers define medical necessity differently. […]
Medicare has adopted a new prior authorization program effective July 1st. Also, as of June 17th, the Medicare Administrative Contractors (MACs) were required to start accepting requests. It is important to note that this is a nationwide program, however, it relies on the local decisions of the MACs. If you put their medical necessity standards […]
In the past 12 months, there were 393 protected health information breach incidents reported to HHS. The incidences included malicious email hacking, unauthorized access to EHRs, and medical records as well as inadequate third-party business agreements. It is our job as healthcare professionals to protect patient health information. Here is a list of common reasons […]
Whether you are a novice or a seasoned negotiator, payer contracts can be complicated and difficult to interpret: even with an attorney or a consultant by your side. Terry Fletcher shares her experience walking physicians and medical practices through this process – something she has done many times over the past 25 years. There are […]
On the latest CodeCast, Terry discusses physician and medical provider addendums, late entries and corrections. CMS and their MAC carriers have referred to this practice as legitimate and are aware it does happen: that is why the Medicare Program Integrity Manual, Chapter 3 addresses the topic. When a deficiency is discovered in a provider’s notes, […]
There are three main sources of funding for mitigating the impact of the COVID-19 pandemic on your healthcare business. Before you being, however, there’s fine print that needs to be read to make sure you can get these sources of money as grants, and not loans. You also have to be careful not to double-dip. […]
Brace yourself: medical audits are coming. With the currently relaxed rules, it is inevitable. The lack of oversight on HHS monies given to practices, and the liberties many are taking with the pandemic, allowing for everyone, it seems, to bill for medical services, something has to give. Have you taken a good look at your […]
