Initial round of audits proves successful for therapy providers. Therapy providers in the Novitas JL jurisdiction have received good news on the initial round of targeted probe-and-educate (TPE) audits.  A total of 93 percent of the 102 therapy reviews received a “minor classification.” Of note, a minor classification can include…
The scoring mechanisms of the MDM are suggested tools, not rules or laws. In our last article we explored how time in conjunction with medical decision-making (MDM) must support the same level of service, and why that rule makes sense. However, we were left with a puzzling consideration in regard…
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…
Pending a possible government shut down, this bill would allow documentation from a home health agency to be considered when records are reviewed.  Late on Feb. 5, the U.S. House of Representatives introduced a “bipartisan” bill to avoid another government shutdown. While the big healthcare news of this bill was…
A quietly introduced rule change should relieve burden on teaching physicians.  How many weeks has it been since I have been critical of the Centers for Medicare & Medicaid Services (CMS)? Probably not too many. Usually it’s about unclear guidance or a missing document. In fact, I could point out…
In the aftermath of the devastation caused by both Hurricanes Harvey and Irma, the Centers for Medicare & Medicaid Services (CMS) has issued blanket waivers of some the regulatory requirements for hospitals and post-acute care settings to support access to services and allow healthcare facilities to provide timely care to…
The June 21 issue of RACmonitor introduced a discussion of the peril of placing blind trust in expert reviews focusing on surgical coding issues. In this article, we will focus on evaluation and management (E&M) review. One E&M expert recently analyzed a number of office visits for a certain provider…