Auditing Antics: Navigating Medical Coding and Auditing

Join us for Episode 7 where we will tackle some of the common E/M questions in the office setting and the thought process behind the answers.

The coding and billing workflow is not only about getting claims out the door. Too many organizations do not have a strong focus on the "backend" and denial management. This can cripple the revenue of a practice. During this episode, we will discuss the various types of structures for a medical organization's billing team internally and/or externally. We will review steps and tips to stay on top of the volume and workflow.

There is a lot of confusion in the coding and billing side of the industry related to preventative services. During this episode we will discuss the differences between a full physical examination that would be relevant to the non-Medicare population and how a wellness visit is different from a workflow and documentation perspective. We will also address "split billing" and how to address, code and bill for active problems that are brought up and managed (or not managed) separate from the preventive care.

Many practices and hospital systems currently have providers prescribing medications and/or are wanting to practice "life style" medicine related to weight loss. These types of services are not always reimbursable by the payers, but in the "pay and chase" environment organizations are getting paid and not aware of the future compliance risks associated. During this episode we will review the medical weight loss programs we are seeing in our audits, discuss the compliance risks and what organizations need to do to address this internally.

During this episode we will discuss the scenario when a provider is planning to perform a service that they expect the insurance to not cover. Is the practice required to notify the patient of this tricky situation? Is the patient responsible to pay out of pocket every single time in every situation? We will review what the medical staff and a patient need to be aware of to prevent reimbursement issues with services that may not be covered.

During this episode we will break down the documentation requirements for medical necessity that are often missing or not detailed in the encounter progress note. We will also review the coding requirements, common payer coverage and how the documentation and billing can impact patient out-of-pocket costs.

Welcome to the Auditing Antics Podcast! During this episode Stephanie will explain the motivation of the podcast and its relevance to not just those of us in the medical industry, but also to help the everyday consumer advocate for their healthcare.