Auditing Antics: Navigating Medical Coding and Auditing

A focused episode answering the most common and highest-risk telehealth questions coming in right now. This episode cuts through confusion around what is actually allowed versus what is temporarily permitted, and where organizations are making assumptions that are leading to denials and audit exposure. Expect clear answers on documentation requirements, place of service selection, modifier usage, audio only limitations, consent, and how virtual supervision impacts compliance. This is a real-time breakdown of what is being questioned by payers today and what needs to change now before it turns into recoupments.

In this episode of Auditing Antics, we recognize Stress Awareness Month with an honest conversation about the mental load and stress that comes with working in medical coding, billing, and compliance, where there is constant pressure to be accurate, meet productivity expectations, stay current with changing guidelines, and navigate audit risk while knowing that even small mistakes can have significant consequences. We discuss the realities many professionals experience but do not always say out loud, including second guessing decisions, balancing speed with accuracy, managing provider expectations, and carrying the weight of compliance responsibility, and this episode is not just about acknowledging that stress but understanding where it comes from, how it impacts your work, and why it matters, especially if you have ever felt overwhelmed trying to get it right while everything around you keeps changing because this conversation reinforces that you are not alone and that the pressure you feel is real.Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contact

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Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcast

View our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/services

View our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership 

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In this episode of Auditing Antics, we ask the questions every practice should be asking, but many are not, when it comes to their risk adjustment and HCC coding processes. Are your workflows built around accuracy and clinical integrity or are they driven by capture and convenience? We walk through the critical questions that uncover gaps in documentation, coding practices, provider involvement, and compliance oversight, including reliance on problem lists, pre populated diagnoses, the role of MEAT criteria, and internal audit processes. This episode highlights where risk adjustment workflows commonly break down and what that means for audit exposure. If your organization is focused on HCC recapture, vendor tools, or productivity driven coding, this conversation will challenge you to step back and evaluate whether your process truly reflects the patient’s current condition and meets compliance expectations, because this is not just about getting the codes right, it is about making sure your process can stand up to scrutiny.Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contact

Sign up for our updates and the latest compliance news here!  https://www.stephanieallardconsulting.com/

Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcast

View our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/services

View our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership 

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This is not just a policy update, it is a shift in workflow. In this episode of Auditing Antics, we break down what UnitedHealthcare (UHC) is really changing and why so many providers are at risk without realizing it. If you are reviewing imaging on the same date as an E M service, that work may no longer be separately reimbursed unless it meets strict interpretation and reporting requirements. We walk through what qualifies as a true interpretation versus a simple review, why global billing is now under increased scrutiny, and how payer edits and documentation expectations will directly impact your claims. This is not just about radiology, it reflects where payer enforcement is going and how quickly reimbursement can shift when workflows and documentation do not align. If your workflow has not changed, your revenue likely will.Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contact

Sign up for our updates and the latest compliance news here!  https://www.stephanieallardconsulting.com/

Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcast

View our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/services

View our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership 

View our Etsy shop here! https://sallardconsulting.etsy.com

In this episode of Auditing Antics, we explore how coding skills evolve through auditing and what it really means to take your knowledge to the next level. While coding provides the foundation, auditing requires a broader focus on documentation integrity, medical necessity, and compliance risk. We break down the key mindset shifts and practical skills needed to move beyond code selection and into analyzing the full clinical picture, helping you strengthen your approach and grow with confidence in a more advanced, compliance focused role.Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contact

Sign up for our updates and the latest compliance news here!  https://www.stephanieallardconsulting.com/

Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcast

View our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/services

View our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership 

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Spravato treatment includes a required two-hour observation period, but many clinics are unclear about what that time should actually involve. In this episode, we explore what needs to happen during the monitoring period and how clinical care responsibilities differ from billing and compliance expectations. We discuss patient monitoring, staff roles, physician involvement, and documentation, along with common workflow approaches that can unintentionally create compliance or billing risk for practices.Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contact

Sign up for our updates and the latest compliance news here!  https://www.stephanieallardconsulting.com/

Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcast

View our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/services

View our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership 

View our Etsy shop here! https://sallardconsulting.etsy.com

Go to https://www.stephanieallardconsulting.com/online-shop/p/peripheral-vascular-lower-extremity-interventions-coding-and-compliance-essentials-1 and use code VASC15 at checkout for a discount on the upcoming Peripheral Vascular Lower Extremity Interventions: Coding and Compliance Essentials Event!

There’s a phrase in compliance that should make every practice pause:“We’ve always done it this way.”In this episode of Auditing Antics, Stephanie and Michele unpack one of the most dangerous patterns in healthcare billing — the normalization of deviance. A coding practice that started small. A billing habit no one questioned. Claims that paid for years without issue. Until one denial. One probe. One data review changed everything.We walk through how long-standing habits become compliance blind spots, why teams genuinely believe they’re doing it right, and how the math of recoupments can unravel years of “routine” billing in a matter of months.Because payment history is not proof of compliance.And comfort is not a compliance strategy.If you’ve ever heard “but it’s always paid,” this episode is for you.Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our Etsy shop here! https://sallardconsulting.etsy.com

Most audits don’t start with a complaint.They start with a pattern.Long before a human reviewer opens a chart, payer analytics are scanning utilization trends, benchmarking providers against peers, and flagging statistical outliers. Sudden shifts in coding levels. High-frequency services. Modifier usage patterns. Even documentation that looks too consistent.In this episode of Auditing Antics, Stephanie and Michele break down how data science drives audit selection and why many providers are flagged without ever realizing their billing trends stand out. We’ll talk about outlier patterns, utilization spikes, and the quiet metrics payers monitor behind the scenes.Because in today’s compliance environment, you’re not just being reviewed by auditors. You’re being watched by the numbers. If you’ve ever thought an audit felt random . This episode will change how you look at your data.Reach Out For Compliance Help Now!https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our Etsy shop here! https://sallardconsulting.etsy.com

Physicians document to reflect clinical care. Auditors review to validate compliance and billing accuracy. Same chart with a completely different lens.In this episode of Auditing Antics, we break down the mindset gap between providers and medical coding auditors. Why does something that feels clinically obvious sometimes fail an audit? Why does intent not always translate to compliant documentation? And what are auditors actually trained to look for that providers may not realize?We’ll explore how clinical thinking and compliance thinking intersect, and where they often disconnect, plus practical ways to bridge that gap. In compliance, it is not about questioning care but instead discussing what the record supports.Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contact

Sign up for our updates and the latest compliance news here!  https://www.stephanieallardconsulting.com/

Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcast

View our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/services

View our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership 

View our Etsy shop here! https://sallardconsulting.etsy.com

Burnout impacts morale and accuracy.In this episode of Auditing Antics, Stephanie and Michele unpack how exhaustion, staffing strain, and constant regulatory shifts quietly increase compliance risk. When teams are stretched thin coding patterns may change. Small oversights turn into denials, downcoding, or audit findings.We’re connecting the dots between human fatigue and operational exposure because compliance mistakes can happen when energy is depleted and teams are struggling to focus.Reach Out For Compliance Help Now!https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our online shop here! https://www.stephanieallardconsulting.com/online-shopView our Etsy shop here!https://sallardconsulting.etsy.com