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EDITOR’S NOTE: This RACmonitor series examines a new type of auditing in healthcare – the use of algorithms. In the first article in this series, “Artificial Intelligence is Coming to Medicare Audits – Is Your Legal Team Obsolete?” Mr. Roche reported on statistical sampling being supplanted by more complex methods…
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AMA’s changes are complementary to the CMS proposed changes to this code set.  The Centers for Medicare & Medicaid Services (CMS) is moving quickly on its strategies for outpatient office evaluation and management (E&M) services, targeted for implementation in 2021, and the American Medical Association (AMA) is working hard to…
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Providers must document the complexity of care for each and every patient. There is a standard misunderstanding of the utilization of time-based documentation and billing. Clearly, over time, many opinions and interpretations of ambiguous guidelines have clouded this topic, and it is time that we get back to the basics…
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Guidance on a common unbundling modifier has shifted frequently during the last decade. Anthem Blue Cross Blue Shield (BCBS) were set to implement a new processing edit with regard to the use of Modifier 25, effective March 1, 2018, but things didn’t go as planned. Anthem instead submitted a letter…
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How many of us remember the 90010? That was an evaluation and management (E&M) code in 1991, prior to the revision that still haunts us today. Back then, in the good old days, E&M codes were qualitative in nature, meaning that their use was based on physicians’ interpretation of the…