Let’s talk targeted probe-and-educate (TPE) audits. TPE audits have turned out to be “wolf audits” in sheep’s clothing. The Centers for Medicare & Medicaid Services (CMS) asserted that the intent of TPE audits is to reduce provider burden and appeals by combining medical review with provider education.

Electronic medical or health records (EMRs) are the computer programs now in almost every doctor’s office. They have become not a boon — but a bane — for both doctor and patient, and boondoggle to the tune of $36 billion dollars of federal (our) money. This was the assessment of...

Billing and coding is always a challenge, but optometrists new to the field of neuro-optometric rehabilitation can find it doubly so, because the charting notes required are very different from a typical optometric visit. In billing for appointments, providers may have the choice of multiple types of CPT codes...

In touting the federal government’s efforts to make the realities of dealing with Recovery Audit Contractors (RACs) more palatable for providers across the country, one of the nation’s top health officials apparently couldn’t help but take a swing at the concept of universal care.

For coding and CDI (clinical documentation improvement/integrity) professionals, it’s exciting to read over the American Hospital Association (AHA) Coding Clinic on ICD-10-CM/PCS. This publication is a must-have document with must-follow guidance.

Not infrequently, in the process of utilization review (UR), we run into situations in which, as physician advisors, we get to review Medicare cases that do not match their original “label” (i.e. the initial status selection was likely not a proper one).