SummaryIn this episode, Sean and Terry discuss the complexities and challenges surrounding upcoding in medical billing and auditing. They explore the implications of upcoding, the importance of accurate documentation, and the consequences of non-compliance. The conversation also touches on prescription drug management and the nuances of E&M coding, emphasizing the need for healthcare providers to adhere to regulations and ensure that billing practices reflect the services rendered. The episode concludes with a reminder of the importance of compliance in the healthcare industry.Takeaways<ul><li>Upcoding is a significant issue in healthcare billing.</li><li>Accurate documentation is crucial to avoid legal issues.</li><li>Providers must ensure that billing reflects actual services rendered.</li><li>Prescription drug management requires clear connections to services provided.</li><li>Incident to services can complicate billing practices.</li><li>Healthcare providers should avoid adding incidental services to visits.</li><li>The risk of upcoding can lead to severe consequences for practices.</li><li>Regular audits can help identify and correct billing issues.</li><li>Education on coding practices is essential for compliance.</li><li>Healthcare professionals must stay informed about regulations and guidelines.</li></ul>

Summary In this episode, Sean and Terry discuss the complexities and challenges surrounding upcoding in medical billing and auditing. They explore the implications of upcoding, the importance of accurate documentation, and the consequences of non-compliance. The conversation also touches on prescription drug management and the nuances of E&M coding, emphasizing the need for healthcare providers to adhere to regulations and ensure that billing practices reflect the services rendered. The episode concludes with a reminder of the importance of compliance in the healthcare industry. TakeawaysUpcoding is a significant issue in healthcare billing.Accurate documentation is crucial to avoid legal issues.Providers must ensure that billing reflects actual services rendered.Prescription drug management requires clear connections to services provided.Incident to services can complicate billing practices.Healthcare providers should avoid adding incidental services to visits.The risk of upcoding can lead to severe consequences for practices.Regular audits can help identify and correct billing issues.Education on coding practices is essential for compliance.Healthcare professionals must stay informed about regulations and guidelines.

SummaryIn this episode, Sean and Terry discuss the complexities and challenges surrounding upcoding in medical billing and auditing. They explore the implications of upcoding, the importance of accurate documentation, and the consequences of non-compliance. The conversation also touches on prescription drug management and the nuances of E&amp;M coding, emphasizing the need for healthcare providers to adhere to regulations and ensure that billing practices reflect the services rendered. The episode concludes with a reminder of the importance of compliance in the healthcare industry.Takeaways<ul><li>Upcoding is a significant issue in healthcare billing.</li><li>Accurate documentation is crucial to avoid legal issues.</li><li>Providers must ensure that billing reflects actual services rendered.</li><li>Prescription drug management requires clear connections to services provided.</li><li>Incident to services can complicate billing practices.</li><li>Healthcare providers should avoid adding incidental services to visits.</li><li>The risk of upcoding can lead to severe consequences for practices.</li><li>Regular audits can help identify and correct billing issues.</li><li>Education on coding practices is essential for compliance.</li><li>Healthcare professionals must stay informed about regulations and guidelines.</li></ul>

Episode 356 - #TerryTuesday - Upcoding of Services and The Risks Associated with Bad Documentation

Sean is the host of “The Compliance Guy” a live production dedicated to the intersection of regulatory compliance and the business of medicine. The show provides timely, accurate, and easy to digest information to healthcare professionals.
The show features interviews of industry leaders, government officials, and others helping to shape the healthcare landscape.
Sean M. Weiss (AKA – The Compliance Guy) has been an industry respected name for more than 25-years. A physician and health system advocate, Sean engages with clients to ensure a “level-playing-field” and due process when allegations and/or accusations of impropriety are leveled by a payor or government investigation agency.


When Sean is not engaging in administrative, civil and criminal matters on behalf of more than 30 nationally recognized law firms and clients, he is serving as a third-party compliance officer for a dozen organization across the country ranging in size and specialty to ensure a “Culture of Compliance”!


Sean is a proud member in good-standing with the National Society of Certified Healthcare Business Consultants (NSCHBC), American Health Lawyers Association (AHLA), National Alliance of Medical Auditing Specialists (NAMAS), and the American Academy of Professional Coders (AAPC). Sean holds (CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC, CMC, CMIS, CMOM) national certifications from the Health Care Compliance Association, The National Alliance of Medical Auditing Specialists, The American Academy of Professional Coders and Practice Management Institute.

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Sean is the host of “The Compliance Guy” a live production dedicated to the intersection of regulatory compliance and the business of medicine. The show provides timely, accurate, and easy to digest information to healthcare professionals. The show features interviews of industry leaders, government officials, and others helping to shape the healthcare landscape. Sean M. Weiss (AKA – The Compliance Guy) has been an industry respected name for more than 25-years. A physician and health system advocate, Sean engages with clients to ensure a “level-playing-field” and due process when allegations and/or accusations of impropriety are leveled by a payor or government investigation agency. When Sean is not engaging in administrative, civil and criminal matters on behalf of more than 30 nationally recognized law firms and clients, he is serving as a third-party compliance officer for a dozen organization across the country ranging in size and specialty to ensure a “Culture of Compliance”! Sean is a proud member in good-standing with the National Society of Certified Healthcare Business Consultants (NSCHBC), American Health Lawyers Association (AHLA), National Alliance of Medical Auditing Specialists (NAMAS), and the American Academy of Professional Coders (AAPC). Sean holds (CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC, CMC, CMIS, CMOM) national certifications from the Health Care Compliance Association, The National Alliance of Medical Auditing Specialists, The American Academy of Professional Coders and Practice Management Institute.

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Episode 356 - #TerryTuesday - Upcoding of Services and The Risks Associated with Bad Documentation

Episode 356 - #TerryTuesday - Upcoding of Services and The Risks Associated with Bad Documentation

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