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table of risk

Comparing 2023 E/M MDM and Table of Risk

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In Evaluation Management
Jun 1st, 2023
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Side by side, the 1995 and 1997 Documentation Guidelines and the 2023 CPT® E/M Services Guidelines aren’t so different. Some hospitals and coding and billing entities are under the impression that the new 2023 CPT® evaluation and management (E/M) services guidelines and code changes make things much easier for coding, billing, and auditing processes. It ...
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Medicare Advantage (MAO)

Ambiguity Surrounding MAO Claim Denials Hampers Fraud Detection

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In Industry News
Apr 4th, 2023
1 Comment
Investigation included 55 million records from 2019. Adjustment codes are sometimes too vague to clearly identify whether a Medicare Advantage Organization (MAO) denied payment for a service, the Office of Inspector General (OIG) concluded in a February 2023 Issue Brief. Without specifics about the services for which the MAO is denying payment, the OIG cannot ...
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CDI specialist

Think Like a CDI Specialist

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In CMS
Jan 3rd, 2023
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Stay on top of the latest government reports to ensure compliance in your organization. When you hear the words “clinical documentation improvement” what do you think of? Many of us may initially think of clinical documentation improvement (CDI) specialists who work to ensure the organization’s medical documentation is clear and accurate in support of compliant ...
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Capture validation

Capture the Complete Clinical Picture With Precision

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In Audit
Sep 1st, 2022
6 Comments
Clinical validation could upend your current risk adjustment policies. The rise of risk adjustment-based managed care programs in the past 15 years within Medicare, Medicaid, and Affordable Care Act (ACA) plans has led to remarkably good news: There has been a significant improvement in the accuracy of the diagnosis codes abstracted from medical documentation among ...
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compliance program

Healthcare Compliance Conference Checks All the Boxes

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In AAPC News
Aug 31st, 2022
1 Comment
AAPC’s second Collaborative Compliance Conference was held Aug. 30-31. Healthcare compliance professionals from around the country came together virtually to learn more about risk, fraud and abuse, current compliance issues, and enforcement trends. There were many first-time conference attendees who were excited to learn something new about compliance from accomplished industry experts and network ...
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