Coding Q&A

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Nearly all of us in the healthcare ecosystem were impacted by the cyberattack on Change Healthcare in February that caused widespread network disruptions. Change Healthcare processes 15 billion healthcare transactions annually and is connected to one-third of patient medical records in the United States. More than 100 Change Healthcare applications across pharmacy, medical, dental, patient engagement, and payment services were affected by the disruptions. Months later, United Health Group (UHG), Change Healthcare’s parent company, said it had restored 30% of its products, while another …
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Heather Rothermel When considering contracting for your clinic, it will be important to know how you plan to market your clinic and to ensure that you align with the needs of your community. Will you be a primary care practice, an urgent care practice, or a blended practice? Thoroughly analyzing your market and competition should help guide this decision, but there is a bevy of things to consider—everything from contract type, credentialing requirements, reimbursement methodologies, participation criteria, and the impact to members of the health plans you contract with. Below …
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Heather Rothermel Consider this scenario: You’ve decided to open an urgent care center. You’ve secured funding, found the perfect location, hired amazing providers, created build-out plans to make it your own, and set a go-live date to open your doors to your community. Then you realize you haven’t started contracting and credentialing. In many markets, contracting and credentialing for a start-up can take 9 to 12 months or longer, and operators must consider this timeline in the early stages. Contracting is the process of establishing a relationship between your entity …
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Benjamin Barlow, MD; Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC The False Claims Act (FCA) is a federal statute enacted in 1863, inspired by defense-contractor fraud during the Civil War. Today it is used to prosecute inappropriate billing in the healthcare setting. Any person who knowingly submits false claims to the government (ie, Medicare, Medicaid, and Tricare) is liable for 3 times the government’s damages plus a penalty that is linked to inflation. Penalties are per claim and can become quite expensive. In the past few years, urgent care has had …
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Brad Laymon, PA, CPC, CEMC Over my career as a physician assistant, I have delved extensively into the intricacies of medical coding guidelines. Through collaborative initiatives with healthcare systems and fellow clinicians, I have been able to identify 9 common, recurring coding pitfalls. This process came with significant time and experience, and I want to share what I’ve learned as my ultimate objective has always been advancing charting accuracy to instill confidence among providers in their coding practices. 1. Failure to ‘Diagnose’ Abnormal Vital Signs Generally, it’s best to add …
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