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Developing an Audit Work Plan to Satisfy Your Compliance Program | Webinar

Recorded September 25th, 2024

Guest Presenter Pam Warren of MaineHealth

The OIG identifies seven elements of an effective Compliance Plan. One of them is conducting internal monitoring and auditing. This presentation will look at what to audit, how to evaluate risk, how to set up your audit process, and how to report your results.

ICD-10-CM Conventions, Structure, and Format: Section I.A

As you read this article, it will be helpful if you have the ICD-10-CM book in front of you. You can download a pdf copy here. And even if you don’t download the entire book, download the Official Guidelines instead. There are four cooperating parties to ICD-10-CM. They publish and update the official guidelines for […]

IRE Inpatient Determinations: Case Studies | Webinar

Recorded August 13th, 2024

Guest Presenter Dr. Amarin “Ty” Alexander

Independent Review Entities review inpatient records for diagnostic accuracy and DRG determinations. This case-study focused webinar will describe important ICD-10-CM Guidelines that establish the rules for these decisions.

G2211 Survey Results

Your comments tell the story Our survey asked if you are billing G2211 and getting paid for it. And, if so, which payers are paying. The disruption of the claims processing system in the U.S., that all but halted claims submission and payment for many groups ,also hindered data collection in our survey.  But combined […]

Home and Nursing Facility Category of Code Rules | Webinar

Recorded March 21st, 2024

This webinar will explain the rules for using Evaluation and Management (E/M) services (E/M) in home and residence locations and nursing and skilled nursing facilities. This includes CMS regulations for nursing facility services. It will discuss reporting multiple E/M services when one of the visits is in a nursing facility, and more.

Coding Multiple Procedures | Examples with Modifiers

Biopsies and lesion destruction codes are often performed at the same patient visit. This leads to questions about bundling and modifiers. There are two steps to billing these correctly and avoiding denials: Check the total RVU values Check the NCCI edits. There is a step-by-step procedure for coding multiple procedures at the end of this […]

E&M: Key up the Focus to Complexity and Risk

Recorded February 15. 2024

Guest Presenter Shannon O. DeConda, CPC, CEMC, CEMA, CPMA, CRTT

Prior to the new E&M guidelines, AMA CPT did not reference medical necessity. The Claims Process Manual was our main point of reference for the statement Medical necessity is the overarching determining factor. While 2021 Documentation Guidelines uses 2 key components of time and MDM, the guidelines came armed with references of medical necessity littered throughout inferring that maybe it’s NOT always just 2 of the 3 key components.

Medicare Advantage Plan Network Issues

Question:  My sister is thinking of enrolling in a Medicare Advantage plan. In our practice, we have issues with pre-authorizations and denials. I’ve warned her about network issues. Is there anything else I should tell her? Answer: I’m so glad you asked. I’ve had this conversation with my own family and friends. Medigap plans If […]

Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions.

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