In January 2021, the billing guidelines changed for office and outpatient-based ambulatory services. During my interview with the C-suite occupants for my physician advisor job, I had this epiphany that the hospital gets paid, too. For those of you who do facility billing, you may not be aware that the…
Is your Electronic Medical Record (EMR) system helping you pass an audit or hurting you?   Editor’s Note: This is the final installment in a four-part series that examines physician documentation issues as seen by an auditor. In the last installment of this four-part series, I want to discuss the…
Why the Highmark decision—since rescinded—was wrong about medical decision-making relative to medical necessity. When payers and coders downcode evaluation and management (E&M) notes based on medical necessity, how do they determine what level of history and exam is medically necessary for a particular presenting problem? The answer: subjectively.  What is…