 "Where did all the money go?"  It’s a valid question. Join us for the next live edition of Talk Ten Tuesdays, when nationally-recognized professional coder, educator, and auditor Terry Fletcher will provide an answer by discussing a topic not addressed often enough: physician under-coding. The bad habit leads to not getting paid for services provided. Multiply those issues by 20 to 30 patient encounters daily, and it’s little wonder that physicians are missing a ton of money – important and well-earned revenue.During the pandemic, many physicians just tried to stay afloat with various programs from the U.S. Department of Health and Human Services (HHS): survival programs such as the Paycheck Protection Program (PPP), PPP loans, and the Provider Relief Fund (PRF). But now, the focus is on recovery. During the broadcast, Fletcher will offer examples of those missed revenue opportunities, along with the reasons why under-coding occurs.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.Tuesday Focus: Change Coping: Keeping your coding department up-to-date and current on changes and guidelines is always a challenge. Fortunately, there are easy lessons to learn as you’ll discover when Shannon DeConda, founder of the National Association of Medical Auditing Specialists (NAMAS) shares come very practical advice.RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

Talk Ten Tuesdays

Where Did All the Money Go?

The American Health Information Management Association (AHIMA) has just released a new practice brief focused on prospective clinical documentation integrity reviews and query alerts.Being revealed for the first time during the next edition of Talk Ten Tuesdays, the practice brief was developed by AHIMA through a workgroup of clinical documentation integrity (CDI) industry experts. The free practice brief explores the need for prospective reviews and the impact they have on the CDI industry. The publication also provides information on the provider perspective and how to manage the data obtained in prospective reviews. Every CDI professional will benefit from the practice brief by recognizing the compliance standards that should be followed when performing prospective health record reviews. The live broadcast will also feature these other segments:CDI Report: Nationally recognized CDI expert Cheryl Ericson, clinical program manager for Iodine Software, will have the Talk Ten Tuesdays CDI Report.Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the broadcast’s Coding Report, and its weekly Listeners Survey.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the News Desk.Point of View: Dennis Jones, Patient Financial Services Administrator at Montefiore Nyack Hospital, will substitute for co-host Erica Remer, MD.

Exclusive: AHIMA Reveals New CDI Brief

Lawmakers are lining up to decide what Medicare will pay for after the COVID-19 public health emergency (PHE) is over – and they are looking confident that they have the votes to include it in a must-pass piece of legislation this year.Congress also seems to be on board with a plan to allow millions of Medicare patients to continue to video-chat with their physicians once the PHE is over. The Medicare advisory committee, MedPAC, has recommended a cautious approach, however, that would temporarily cover some telehealth services for all beneficiaries, but revert to lower reimbursement rates post-crisis for virtual appointments compared to in-person. There&apos;s also concern that a rapid expansion could prompt more fraudulent billings: the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) estimates that $4.5 billion in telehealth-related fraud was lost last year, which is why Part B evaluation and management (E&M) services provided during the PHE is on the current OIG 2021 Work Plan.Nationally recognized physician auditor, educator, and coder Terry Fletcher will report on this developing story during the next live edition of Talk Ten Tuesdays.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

Virtual Care: New Issues for Coders

“Querying is the lifeline of clinical documentation integrity (CDI) professionals and many coding professionals,” wrote Cheryl Ericson in a recent edition of ICD10monitor. And yet the query process can be a time-consuming and sometimes arduous activity that often contributes to an inefficient CDI workflow.One of the biggest hindrances to an efficient query process appears to hinge on misinformation regarding what is considered a leading or non-compliant query, specifically as it pertains to the timing of a query. Ericson, a senior healthcare consultant, will report on this lead story during the next live edition of Talk Ten Tuesdays, sorting through the confusion of the query process while helping you ensure that queries at your facility are compliant and non-leading.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.Mental Health Report: To mask or not to mask, that is the question. Recent guidelines from the Centers for Disease Control and Prevention (CDC) say that fully vaccinated adults need not wear masks. That announcement, however, is creating confusion – and, among some individuals, a level of anxiety. Reporting on what is making folks anxious as the nation transitions from the pandemic and into summer will be H. Steven Moffic, MD: an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry, a prolific writer and speaker, and the Talk Ten Tuesdays resident psychiatrist.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

To Query or Not to Query: That’s the Leading Question

Are you monitoring the 2021 U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan? The watchdog agency is watching you. They’re auditing claims for evaluation and management (E&M) services performed on the same day as minor surgical procedures that have been documented with Modifier 25. The backstory: in 2019, about 56 percent of dermatologists&apos; claims with an E&M service also included minor surgical procedures (such as lesion removals, destructions, and biopsies) on the same day. This may indicate abuse, wherein the provider used Modifier 25 to bill Medicare for a significant and separately identifiable E&M service when only a minor surgical procedure and related preoperative and postoperative services were supported by the beneficiary&apos;s medical record. Nationally recognized professional coder, educator, and auditor Terry Fletcher will return to the Talk Ten Tuesdays broadcast for its next edition to report the lead story. The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey. Tuesday Focus: Homework: Many auditors and coders are working from home these days, and home has raised new obstacles and some new advantages to our daily routines. How to bring the home practicality into the coding and auditing work world will be Shannon DeConda, founder of the National Alliance of Medical Auditing Specialist (NAMAS). News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.Point of View: Dennis Jones, Patient Financial Services Administrator at Montefiore Nyack Hospital, will substitute for co-host Erica Remer, MD.

OIG Getting Under the Skin of Dermatologists: E&M Services and Modifier 25

The ongoing quest to improve quality includes the auditing of low-value services. During the next episode of Talk Ten Tuesdays, Susan Gatehouse, founder and CEO for Axea Solutions, will report on areas to reduce wasteful spending on services with little to no clinical benefit – all in the name of improving quality of care.According to most industry definitions, low-value care involves those services that are medically unnecessary and provide no health benefits to patients.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.Tuesday Focus: HIM Professionals Engaging Physicians (Part IV): Rose Dunn will continue with her series on how health information management (HIM) professionals, using their existing skill sets, can enhance physician practices in the outpatient environment.  News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.Developing Story: Nationally recognized professional coder, educator, and auditor Terry Fletcher will return to the broadcast to report on the continuing saga of the American Medical Association (AMA) versus the Centers for Medicare & Medicaid Services (CMS), concerning the use of the prolonged care code 99417.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

The Quest to Improve Quality: Auditing Low-Value Services

Outsourcing versus offshoring – a debate long representing a tacit acknowledgment of how many U.S. facilities and physician practices approach coding and billing – has resurfaced as providers grapple with which to choose as the customary way to submit medical claims. Although once considered verboten, today this is more or less becoming mainstream, or the "new normal," with globalization on the horizon.But should your facility consider outsourcing medical coding and billing – and if you do, how much is actually "off-shored," even if you contract with a U.S.-based company? Do you know who&apos;s working for you?Nationally recognized professional coder, educator, and auditor Terry Fletcher will discuss the good, the bad, and the ugly of outsourcing and offshoring as she busts myths and re-examines the reality of contracting rather than keeping coding and billing in-house during the next live edition of Talk Ten Tuesdays.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk-Ten-Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.Tuesday Focus: HIM Professionals Engaging Physicians (Part III): Rose Dunn will continue with her series on how health information management (HIM) professionals, using their existing skill sets, can enhance physician practices in the outpatient environment. News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk-Ten-Tuesdays News Desk.RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

Outsourcing versus Offshoring: Old Issue, New Insights

The American Medical Association (AMA) CPT® Errata and Technical Corrections have clarified some grey areas found in the 2021 Evaluation and Management (E&M) Guidelines. But did the updates really help coders and physicians in better understanding how to apply the latest corrections?Apparently, there’s still confusion, according to Terry Fletcher, a nationally recognized physician auditor and coder. Fletcher will return to the Talk Ten Tuesdays weekly broadcast to offer some working examples, as well as answer listener questions, in an effort to clear up the perplexities while providing insight on how to submit a clean office visit claim.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.Tuesday Focus: Hospital at Home versus Hospital to Home: Are they not one in the same? Clearing up any confusion on this issue will be Tiffany Ferguson, CEO at Phoenix Medical Management, Inc.  Developing Story: Sepsis and New York: The Empire State Strikes Back: Dennis Jones, patient financial services administrator at Montefiore, Nyack, will report on why New York said “no way” to UnitedHealthcare.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

AMA 2021 CPT® Errata and Technical Corrections: Mitigating Shades of Grey

Healthcare providers nationwide are scanning the horizon for the first signs of ICD-11, which is slowly making its presence seen and felt.However far in the future you might speculate the transition to ICD-11 to be, the reality is that preparation and planning will take time, and understanding the new concepts being introduced is a key starting point. And that will be where we start during the next live edition of Talk-Ten-Tuesdays; join Chuck Buck and Dr. Erica Remer when they welcome the return of Susan Gatehouse, founder and CEO of Axea Solutions, who will report the lead story.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.Mental Health Report: May is Mental Health Awareness Month, and here at Talk Ten Tuesdays, we continue to recognize the importance of this pressing national issue. Erin Head, senior healthcare consultant with Iron Mountain and coding auditor with Code and Comply Specialists, will join the broadcast to report on current challenges in behavioral health coding, focusing on telehealth coding best practices, plus key Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) guidelines, and the importance of psych history codes, and provider documentation improvement.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

ICD-11 Prep: Examining Prominent Changes in Preparation for the Transition

When the Centers for Medicare & Medicaid Services (CMS) began down the path of change that the American Medical Association (AMA) delivered in 2021 for the purpose of administrative burden relief, it was expected that there would be some initial investments of time necessary to create models of efficiency in a new era of documentation.But most providers have chosen to avoid it. The totality is the patient story. And hasn’t that been the problem since the inception of templates, and one of the other reasons many rallied for changes to the guidelines?Templates and stern requirements regarding how the patient encounter is documented tend to change – and at times, strangle – the story of the patient. But we must remember that the pen is mightier than the electronic medical record (EMR) – and that the author of the note is, in fact, the ultimate authority of it, and the controller of its destiny. Reporting our lead story during the next live edition of Talk Ten Tuesdays will be Shannon DeConda, who will return to the broadcast to take a deeper dive into a subject that has continued to generate buzz since her last appearance several weeks ago..The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.  News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.Mental Health Report: May is Mental Health Awareness Month. The National Alliance on Mental Illness estimates that 1 in 5 U.S. adults experience mental illness each year, noting that 50 percent of all lifetime mental illness begins by the age of 15. Offering comment and context on the state of mental health in the United States will be Dr. H. Steven Moffic, award-winning author and internationally renowned psychiatrist.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

The Pen is Mightier than the EMR

It’s vitally important to remember that updates to the American Medical Association (AMA) CPT® code book might not be there when you need them.But since January of this year, the AMA has been receiving provider feedback: essential information that now been incorporated in the AMA 2021 CPT® Errata and Technical Corrections. Navigating these changes during the next edition of Talk Ten Tuesdays will be nationally recognized physician auditor and coder Terry Fletcher, who will report on significant clarifications – including some evaluation and management (E&M) 2021 Office and Other Outpatient visit clarifications – designed to help practices square their visits with medical decision-making (MDM).The live broadcast will also feature these other segments:Tuesday Focus: HIM Professionals Engaging Physicians (Part II): Rose Dunn will continue with her series on how health information management (HIM) professionals, using their existing skill sets, can enhance physician practices in the outpatient environment.  News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment. 

Why it’s important to get a handle on CPT® Errata

There’s a new segment of the healthcare population that represents yet another opportunity for health information management (HIM) professionals to leverage existing staff and processes to improve their organization’s bottom line. That new segment: physicians employed by healthcare systems.During the next live edition of Talk-Ten-Tuesdays, nationally acclaimed HIM professional Rose T. Dunn, two-term president of the American Health Information Management Association (AHIMA) and chief operations officer for First Class Solutions, will return to the broadcast to report on important strategies to engage physicians – this being the first of a two-part series. Of particular relevance is the fact that now, according to the 21st Century Cures Act, consumers have been empowered to read notes that recap doctor office visits, as well as look at test results electronically. As such, now is the time for everyone at your facility to get on the same page.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.Tuesday Focus: Shannon DeConda, founder of the National Alliance of Medical Auditing Specialists (NAMAS), will return to the broadcast with an update on evaluation and management (E&M) codes.Mental Health Report: Sexism: Sexism, like racism, causes all sorts of psychiatric problems and diagnoses. Though sexism towards females is more obvious, we in healthcare shouldn’t ignore its occurrence in men, too, according to Dr. H. Steven Moffic, award-winning author and internationally renowned psychiatrist, who will return to the broadcast to report on this hot-button topic – and also comment on the Derek Chauvin verdict that captured the world’s attention.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

How to Ensure Data Integrity While Protecting Your Organization’s Bottom Line - Part I

A key (and occasionally overlooked) role of the physician advisor is advocacy: advocacy for physician partners, advocacy for quality patient outcomes, and advocacy for clinical medicine represented on committees, in board rooms, and to agencies defining national standards.During the next live edition of Talk Ten Tuesdays, Dr. Drew Updike, medical director of coding at UCHealth, and Dr. Debra Anoff, senior medical director of clinical documentation improvement (CDI) for UCHealth, will offer a blueprint on how they solved a local problem on a national level.They identified a blind spot in Agency for Healthcare Research and Quality (AHRQ) criteria that was negatively impacting their organization&apos;s PSI-06 Quality ranking, as a result of their being a regional referral center for a highly specialized congenital corrective surgery (the “Nuss” procedure).After collaborating cross-sectionally within their organization, they engaged in advocacy to AHRQ; the result was successful modification of PSI-06 criteria, based in sound clinical reasoning.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.This episode is sponsored by:AHIMA, MRA and AHDAM

When Surgeons Have Had Enough— Modifying PSI-06 Criteria for AHRQ

Every day, in facilities ranging from small rural hospitals to large academic teaching facilities and health systems, these dedicated professionals are working to keep patient health information data accurate, secure, and most importantly, personal. Because when it’s personal, it’s relevant.As part of our recognition of the importance of HIPs, please listen to HIP Voices, a podcast during which you’ll hear the stories of three dedicated professionals:Laurie Peters, Global privacy officer at Orion HealthSarah Throop, who describes her journey into telehealth and virtual care.Shannan Swafford, Manages coding process improvement, BlueCross Blue Shield of Tennessee

HIP Voices

ICD10monitor and Talk Ten Tuesdays will continue their reporting on the advent of ICD-11 – particularly during April, when attention turns to the World Health Organization (WHO).A key question that needs answering: where does the United States fall among the countries that are either preparing or even implementing the new update for the standard code set?For a global perspective on ICD-11 and the nation’s position on the new code set, Margaret Skurka, a member of the International Federation of Health Information Management Associations (IFHIMA) and past president of the American Health Information Management (AHIMA),will share perspective on ICD-11 planning during the next edition of Talk Ten Tuesdays. The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey.RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on two proposal rules posted by CMS.Mental Health Report: Anti-Asian Discrimination: Nearly 3,800 incidents have been reported by the Stop Asian American Pacific Islander (AAPI) Hate reporting center from March 2020 through February 2021. There is an ICD-10 code to specify a diagnosis of being a victim of crime and terrorism. Reporting this troubling issue will be Dr. H. Steven Moffic, award-winning author and internationally renowned psychiatrist.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

ICD-11: Where in the World is the U.S.?

Get the most up-to-minute news and information on ICD-10. Join Chuck Buck and Erica Remer, MD, FACEP, CCDS, every Tuesday as they welcome ICD10monitor contributing editors and special guests to monitor and report on the progress that all healthcare stakeholders are experiencing in their respective implementations of ICD-10. Register to attend live here: https://event.webcasts.com/starthere.jsp?ei=1236510&tp_key=da0e4c0f76

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Talk Ten Tuesdays

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