In a legal lawsuit, one party is initially presumed to be correct and gets the benefit of the doubt, while the other side bears the burden of proof. When a party bearing the burden of proof meets its burden, it switches to the other side.

Tina R. Strawn, RN, administrative director of operations for patient financial services at Houston-based Harris Health System, has 27 years of healthcare experience. Throughout her career, she has worked in patient care, bed management, transfer center coordination, case management, nurse auditing, denial management, charge...

It’s every physician’s worst nightmare: Receive payment for services rendered, but then a payer identifies an aberrant pattern in claims data, audits the records, decides it has overpaid the practice, and recoups those funds. That money you already allocated for overhead, staff salaries, bonuses, or new medical equipment? Gone. With one...

Another day, another change to E/M plans for 2021! Medicare has released the 2020 proposed rule for the Medicare Physician Fee Schedule (MPFS), bringing in the recent AMA plan to revise E/M coding in 2021. But what does the MPFS say about Medicare payment for office/outpatient visits in 2021? Here’s the scoop.

In the first part of this series, we examined audit risks associated with observation claims. We should review what other risk areas providers might expect and why, as Recovery Audit Contractors (RACs) ramp up reviews again.