Blog post
April 7, 2021 / By Barbara Aubry, RN
I had to smile when I saw the article in the March 3, 2021 RAC Monitor titled “Expect More Medical Record Audits Under Biden.” Compliance activities took a bit of […]
Blog post
Feb. 15, 2021 / By Barbara Aubry, RN
Hopefully, everyone is using the new E/M codes without issue. CMS added two HCPCS codes to represent “additional” time for E/M services. These are important qualifiers, as medical necessity audits […]
Blog post
Aug. 26, 2020 / By Barbara Aubry, RN
I know y’all don’t want to hear from me twice in one month, but I saw a report recently that I had to share following the concerns I discussed in […]
Blog post
Aug. 10, 2020 / By Barbara Aubry, RN
Sometimes I think I read way too much about the novel coronavirus. The more we learn about the virus, the more twists and turns are uncovered. Apparently, antibodies don’t necessarily […]
Blog post
May 22, 2020 / By Barbara Aubry, RN
Last time I blogged, I had hoped that by the deadline for my next blog we would have some more effective forms of treatment for COVID-19 or better containment and […]
Blog post
March 25, 2020 / By Barbara Aubry, RN
My blog posts discuss healthcare compliance issues and normally I focus on CMS, OIG, audits, coding and rules. But at this unusual time, I’m finding it challenging to focus on […]
Blog post
Feb. 14, 2020 / By Barbara Aubry, RN
Audits of Hierarchical Condition Categories (HCCs) have been performed for years as a way for Part C vendors (Medicare Advantage Organizations) to identify and support patients with complex needs. Higher […]
Blog post
Dec. 9, 2019 / By Barbara Aubry, RN
On December 3, I attended the CMS call on the final rule for hospital price transparency requirements. On December 4, I read an article in the New York Times stating […]
Blog post
Nov. 8, 2019 / By Barbara Aubry, RN
While reading a recent CMS release regarding proposed updates to the Stark Law, I was reminded that it was first released in 1998. With value-based reimbursement, relationships between providers has […]
Blog post
Oct. 2, 2019 / By Barbara Aubry, RN
This has been in the works for a while: On July 26, 2019 CMS released CR Transmittal R2323OTN, Med Learn Matters number 11268 to take effect January 1, 2020 with […]
Blog post
Sept. 6, 2019 / By Barbara Aubry, RN
In case you missed the release of the Medicare Learning Network (MLN) Matters article SE19012 on June 27, 2019, I wanted to share some insights for all the compliance folks […]
Blog post
Aug. 14, 2019 / By Barbara Aubry, RN
For those involved in coding and compliance, this is not the first time attempted changes to E/M rules have been proposed. Remember 1995 and 1997? Of course, I’m way too […]
Blog post
July 17, 2019 / By Barbara Aubry, RN
The country is revving up for the next election cycle. Like it or not, health care is a focus again and some sword-rattling is taking place regarding the IPPS (Inpatient […]
Blog post
May 20, 2019 / By Barbara Aubry, RN
Oh great—more new modifiers! If you’re like me, I read my CMS updates and focus on what needs to be managed based on regulatory deadlines. Back in 2016, I read […]
Blog post
April 22, 2019 / By Barbara Aubry, RN
The March 19, 2019 letter from Seema Verma, CMS Administrator, to Charles Grassley (Chairman of the Committee on finance) assures that CMS is once again analyzing claims data to determine […]
Blog post
March 18, 2019 / By Barbara Aubry, RN
According to a March 7, 2019 article in Modern Healthcare, the Medicare Payment Advisory Commission (MedPAC) has decided to recommend that HHS revisit the national ED coding rules by 2022, citing […]
Blog post
Feb. 11, 2019 / By Barbara Aubry, RN
On January 24, 2019 CMS released MNL Matters article SE19002, effective January 1, 2018. The change applies to acute care, long-term care and critical access hospitals. As of January 1, […]
Blog post
Dec. 19, 2018 / By Barbara Aubry, RN
Yesterday, I saw a new release from CMS clarifying documentation requirements for E/M services in 2019. Little has changed about the data that needs to be collected, but there has […]
Blog post
Dec. 5, 2018 / By Barbara Aubry, RN
The online portal Dictionary describes healthcare as “noun; the maintenance and improvement of physical and mental health, especially through the provision of medical services”. Interesting that it does not mention […]
Blog post
Nov. 12, 2018 / By Barbara Aubry, RN
On November 8, 2018 CMS released its Dear Clinician letter providing final decisions on the proposed Evaluation and Management coding changes discussed in a previous blog. The letter is a […]
Blog post
Oct. 5, 2018 / By Barbara Aubry, RN
On October 3, 2018, CMS released CR 10901, Transmittal R829PI, effective October 3, 2018 with an implementation date of January 8, 2019. This is an important modification to the LCD […]
Blog post
Sept. 12, 2018 / By Barbara Aubry, RN
There has been an outcry about the proposed E/M changes CMS recently brought to the industry for comment. Let’s take a close look at what CMS proposes: Lifting restrictions on […]
Blog post
July 23, 2018 / By Barbara Aubry, RN
I don’t know about you, but my head is spinning. On July 12, 2018, Administrator Verma released an email with some pretty stunning news. I’m going to focus on the […]
Blog post
July 16, 2018 / By Barbara Aubry, RN
I’ve been talking about this for years. I still see folks who don’t think compliance with medical necessity polices is critical. Believe me, I understand human nature; noncompliance can be […]
Blog post
June 20, 2018 / By Barbara Aubry, RN
In my last blog, I commented on being overcharged by my PBM for a medication that had been removed from their formulary – allegedly because the FDA pulled some old […]
Blog post
May 7, 2018 / By Barbara Aubry, RN
The healthcare industry (like every other) has often used catch words and phrases: Patient empowerment, population health, electronic interoperability, pay-for-performance, quality metrics, social factors that affect outcomes, medication compliance, care […]
Blog post
April 9, 2018 / By Barbara Aubry, RN
If you listen, watch or stream news updates then you’ve likely heard about the Facebook data privacy scandal. During a recent early morning treadmill jaunt, I listened to a CNBC […]
Blog post
March 7, 2018 / By Barbara Aubry, RN
I review OIG updates as they are released and I saw something last week that unfortunately, I did not find surprising. Per the OIG report: “Payments made to providers for […]
Blog post
Feb. 12, 2018 / By Barbara Aubry, RN
In late December 2017, I was asked by a colleague for my opinion on a customer’s inquiry about modifier 52 and its use in mammograms. CPT® modifier 52 represents a […]
Blog post
Jan. 17, 2018 / By Barbara Aubry, RN
I attended the January 9, 2018 CMS Medicare Learning Network conference call covering the logistics of the settlement process offered by CMS for providers with pending appeals. This impacts: “The […]