Auditing Antics: Navigating Medical Coding and Auditing

A note may contain a long list of lab tests, imaging studies, and outside records. But which of those items actually count toward the data element of E/M medical decision making?

In this episode of Auditing Antics, Stephanie and Michele break down the questions that come up when auditing E/M data. They discuss the difference between an order, a result review, and information that is simply carried into the note.

They also explore why ordering and later reviewing the same test does not automatically give you two data points, and why the number of items in a chart does not tell the whole story.

If you code, audit, or document E/M services, this episode will help you take a closer look at what the clinician did with the data and what the record supports.

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Ep. 121 - Medicare Advantage: The Payer Tactics Practices Need to Know (ft. Stephanie Allard)
🍎 Apple Podcasts: https://podcasts.apple.com/us/podcast/ep-121-medicare-advantage-the-payer-tactics-practices/id1746629912?i=1000791075227
🟢 Spotify: https://open.spotify.com/episode/2cpXMNNbaMWM7hRaBcqUq3Those of us who work in healthcare understand how complex Medicare choices can be and how significantly those decisions can affect access to physicians, specialists, hospitals, medications, and other necessary services.In this episode, we discuss why healthcare professionals should take the initiative to share what we know with our patients, families, and communities. We break down the differences between Original Medicare and Medicare Advantage, highlight important questions people should ask before enrolling, and explore how better education can help individuals make informed choices based on their healthcare needs instead of relying solely on premiums, advertisements, or added benefits.

Surgery may be mentioned throughout multiple progress notes, but that does not mean every encounter supports a decision regarding surgery. In this episode, Stephanie and Michele explain the difference between discussing surgery as a future possibility and documenting an actual surgical decision. They review what coders should look for, including the provider’s recommendation, treatment alternatives, patient-specific risks, the patient’s choice, and the resulting plan. They also discuss decisions to proceed, postpone, or decline surgery.

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A diagnosis appearing in the medical record does not automatically count toward the E/M level. In this episode, Stephanie and Michele break down one of the most misunderstood elements of medical decision-making: the number and complexity of problems addressed. They discuss the difference between problems that are listed, mentioned, monitored, evaluated, and actively managed—and explain how terms such as stable, worsening, exacerbated, acute, and uncertain affect code selection. Using practical examples, they show why the same diagnosis can support different E/M levels and what documentation is needed to demonstrate the provider’s work.

For the first time on the Auditing Antics Podcast, Michele Strickland and Stephanie Allard are recording live and together in person!

In this episode, Michele and Stephanie break down the biggest highlights from the CY 2027 Medicare Physician Fee Schedule Proposed Rule and talk through what these proposals could actually mean for healthcare organizations and physician practices. From the proposed Modifier 25 payment reduction and changes to G2211, to new ACO incentives, remote patient monitoring requirements, telehealth updates, MIPS changes, and continued pressure on physician reimbursement, there is a lot for practices to pay attention to.

As always, they go beyond simply reading the rule and discuss the real world impact on coding, compliance, reimbursement, and practice workflows.

And this episode is a little more fun because after all of their remote podcast recordings, Michele and Stephanie are finally sitting across from each other recording Auditing Antics together in person!

https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2027-ipps-final-rule-home-page

AI is rapidly becoming part of healthcare operations, but implementing the technology is only the beginning. How do organizations know their AI tools are secure, accurate, compliant, and continuing to perform as intended?In this episode of Auditing Antics, we’re joined by Bennett Borden, Founder and CEO of Clarion AI Partners, to discuss the use, implementation, governance, and ongoing monitoring of AI in healthcare. Bennett brings a unique background spanning service with the CIA and U.S. Intelligence, law, data science, and AI governance.We’ll discuss what healthcare organizations should consider before implementing AI, why human oversight and ongoing monitoring matter, and how to make sure AI innovation doesn’t create new compliance and security risks.🔗 Click here to learn more about Bennett and Clarion AI Partnershttps://clarionai.com/

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Coding is evolving, and so is the role of coders and auditors. As AI and automation take over more routine coding tasks, the real value comes from understanding the regulations, payer policies, CMS guidance, and compliance principles behind every code. In this episode of Auditing Antics, we're discussing why compliance knowledge and critical thinking are becoming the most valuable skills in healthcare coding and auditing.

Coders are the last line of defense before a claim is submitted, yet audit after audit continues to reveal fundamental coding and documentation errors that should have been identified long before billing. In this episode of Auditing Antics, we're discussing why coding quality appears to be slipping and the growing impact it's having on compliance, reimbursement, and audit risk. We'll explore how inadequate training, production pressures, overreliance on technology, and limited quality oversight are contributing to these issues, while reinforcing that coders have a professional responsibility to recognize documentation deficiencies, apply coding guidelines correctly, and question records that do not support the codes being assigned. Coding is more than selecting codes from a note. It requires critical thinking, regulatory knowledge, and accountability. Join us as we discuss the trends we're seeing in real-world audits, why these mistakes continue to occur, and what organizations can do to strengthen coding quality before payers and auditors find the errors first.#AuditingAntics #MedicalCoding #CodingQuality #MedicalAudits #HealthcareCompliance #CodingEducation #MedicalBilling #ClinicalDocumentation #RevenueCycle #DocumentationIntegrity #ComplianceMatters #HealthcareLeadership #RiskManagement #ProviderEducation #HealthcarePodcast

Join us for an E/M Q&A on Documentation, MDM, and Time as we answer some of the most common questions providers, coders, billers, and compliance professionals face. From selecting the correct E/M level to understanding medical decision making requirements and time-based billing rules, we'll break down real-world scenarios, audit risks, and documentation tips to help you improve compliance and coding accuracy. #EMCoding #EvaluationAndManagement #MedicalCoding #HealthcareCompliance #MedicalAuditing #CodingAudit #AuditReady #MedicalDocumentation #MDM #HealthcareBilling #RevenueCycleManagement #HealthcareConsulting #ProviderEducation #CodingEducation #HealthcareAdministration #RiskManagement #AuditingAntics #CodingCommunity #MedicalCoder #ComplianceMatters

Summer can be one of the busiest times of year for healthcare coding, billing, auditing, and compliance professionals, making it easy to overlook the signs of burnout. In this episode of Auditing Antics, Stephanie and Michele discuss the realities of summer burnout in healthcare compliance and share affordable, practical ways to recharge without spending thousands on a vacation. From staycations and local adventures to setting boundaries, unplugging from work, and making time for yourself, we'll explore how small changes can have a big impact on your well-being, productivity, and long-term career success. #AuditingAntics #HealthcareCompliance #MedicalCoding #MedicalBilling #RevenueCycleManagement #HealthcareAudit #HealthcareConsulting #ComplianceProfessional #HealthcareLeadership #BurnoutPrevention #WorkLifeBalance #RevenueIntegrity #HealthcareOperations #MedicalAuditing #HealthcareEducation #HealthcarePodcast #CodingLife #ComplianceMatters #SummerBurnout #SelfCare