Posted and filed under Compliance, Medical Record Auditing.

Sign, Seal, Deliver: Provider Signature Requirements

To a physician, providing authentication may appear as yet another inconvenience or hindrance to productivity in the midst of the already chaotic audit process – but it’s the difference between being reimbursed and having your claims denied. For the purpose of a medical record audit, Medicare requires that any services provided be authenticated within the…

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Posted and filed under Coding, Medical Record Auditing, Payers.

Think Twice Before Appending Modifiers

Coding Modifiers In the English language, a modifier is used to describe the who, what, how, why, and/or where of a situation. Coding modifiers perform the same role for medical coders and billers. These types of modifiers further describe procedure codes without altering its original definition. Modifiers can be found in both the CPT and…

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Posted and filed under Compliance, Medical Record Auditing.

Surviving the Medical Record Retrieval Process

Tackling a project as intricate as Medical Record Retrievals may seem daunting – and it is, but you can still make it through unscathed. Perhaps your firm was enlisted by an attorney, health plan, or medical auditing organization to retrieve medical records directly from a provider’s office. What tools do you need? How do you…

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Posted and filed under FWA, Medical Record Auditing.

How to Deliver Quality Litigation Support Services

If you were an attendee at last month’s webinar on arbitration and litigation support for medical coders and auditors, you’re aware of the fact that legal support is a growing need in the healthcare industry. It may come as no surprise given the alarming numbers associated with Medicare fraud in the United States, that more…

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Posted and filed under Coding, Medical Record Auditing.

Keep M.E.A.T. on Your List for a Healthy Audit

If you’re reading this article, chances are you already know what HCC Coding is – but we’ll give you a refresher anyway. Hierarchical Condition Category (HCC) and Risk Adjustment Coding is a CMS-mandated payment model. This particular model works to identify those with chronic and other serious illnesses and prescribes a risk factor score to…

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Posted and filed under Coding, Medical Record Auditing.

Overview of Colonoscopy Coding

Diagnostic Colonoscopy A diagnostic colonoscopy is a test performed as a result of an abnormal finding, sign, or symptom (such as diarrhea, abdominal pain, etc.). Factors for Consideration: Symptoms before the procedure such as a change in bowel habits, rectal bleeding, etc. Findings during the procedure (polyp, cancer, diverticulosis, etc.) Personal history of cancer or…

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Posted and filed under Medical Record Auditing, Payers.

The Claims Denial Epidemic

The American Hospital Association recently released the results of a survey conducted to explore the efficacy of the RAC program in hospitals nationwide. The survey utilized the results responses submitted by 676 participating hospitals in order to explore the program’s impact in the second quarter of the year 2016. The results suggest that while Medicare…

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Posted and filed under Medical Record Auditing.

Staying Productive in Gale Force Winds

Hurricane Matthew flooded headlines earlier this month as it approached Advize Health’s home-base of Tampa Bay, threatening to eliminate power-lines and productivity. The threat of the storm had the Advize Health team working in overdrive, strategizing ways to stay safe and effective while hunkering down. With the power flickering and winds picking up, Advize Health…

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Posted and filed under FWA, Medical Record Auditing.

The Great Divide: Federal vs. Commercial Health Plan Reviews

Commercial Health Plans The act of tailoring medical record audit procedures to the needs of a particular health plan is not a novel concept. Different commercial healthcare payers maintain requirements unique to their served populations, and audits are consistently slightly augmented in order to focus on E/M, specific and proper modifier usage, and other various…

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Posted and filed under Coding, FWA, Medical Record Auditing.

How Much Are Your Policies Costing You?

A medical record audit can reveal over-payments for up-coding, incorrect numbers of units billed, and the abuse of modifiers – just to list a few. Given the popularity of such indiscretions, what is being done after the money is recovered? Do you intend on data mining again in six months, hoping that the provider will…

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