Practice Management
Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Three elements determine the level for evaluation and management coding (E/M). “Amount and/or Complexity of Data to be Reviewed and Analyzed” is 1 of them and also the most confusing. Data Reviewed remained a point system after guidelines changed in 2021. As an auditor, I see both undercoding and overcoding in E/M caused by not applying the rules correctly. Let’s start with what tests count toward Data Reviewed. …
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We are deep into the fourth quarter of 2024, and you are probably preparing for the holidays and wrapping up year-end projects. As we celebrate the end of the year, it is important to also look ahead and lay the groundwork for revenue cycle management success in 2025. Following are some points to consider in your strategic plan for next year. Contract Renegotiations Understanding your payer agreements and your patient population will be instrumental to …
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Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC We are heading into fall, and fall starts with updates to the ICD-10-CM codes. The most recent changes went into effect on October 1, 2024. There is no grace period. Because ICD-10-CM codes are date-specific, claims prior to date of service October 1, 2024, need to use the codes for that time period, switching over to the update on the exact day. While ICD-10-CM codes are updated semi-annually, …
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Over the past 2 decades, urgent care has been on the forefront of consumerism. Increasingly, healthcare consumers are realizing how much they are contributing to the cost of healthcare delivery through taxes and payroll premium deductions, and therefore, they’re more motivated than ever to attain the full value of the benefits they’ve paid for. Urgent care has remained focused on the consumers’ sense of value by appealing directly to patients as clinics market their convenient …
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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 …
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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, …
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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 …
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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 …
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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 …
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Benjamin Barlow, MD; Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC One of the biggest challenges facing urgent care operators is increased scrutiny in the form of payer reviews. More clients than ever are facing these administrative and financial burdens. Compounding the issue is that urgent care clinicians often struggle to understand coding guidelines and how to document in a way that shows their medical decision making, which is vital in care and in payer reviews. Prepayment …
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