Catherine Short speaks with Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX, on the topic of “The No Surprises Act – What You Need to Know.” Effective January 1, 2022, the No Surprises Act has implications for patients, providers, and insurance companies alike. The impetus behind the legislation, as well as the regulations, is to prevent patients from receiving bills for certain services that were performed or delivered by providers out of their plan’s network. The scope is limited and providers and plans alike need to take steps to understand the appeal process when a payment or claim is challenged. The purpose of this episode is to provide a brief overview of the evolution of the United States’ healthcare system and its relevance to the No Surprises Act. From there, the No Surprises Act and regulations will be explained, along with the appeal process. Finally, compliance tips will round out the show.
Melody W. Mulaik, MSHS, FAHRA, CRA, RCC, RCC-IR, CPC, CPC-H is the President of Revenue Cycle Coding Strategies LLC and our esteemed presenter. 2022 was scheduled to be the the official implementation date for AUC/CDS implementation but the 2022 Proposed Rule threw everyone a little curve ball. While a delay will occur it does not change the direction of the program or the need to prepare and test. As providers continue to either prepare their own practices or bridge the gap with imaging facilities, it is important that everyone be on the same page throughout the CMS implementation and remaining testing period.
Catherine Short speaks with Melody Mulaik, President of Revenue Cycle Coding Strategies, a dynamic company that works with physician practices, healthcare systems, billing companies and other industry stakeholders to provide auditing, education and other collaborative consulting solutions to meet their coding and compliance needs. First Healthcare Compliance is a proud partner of Revenue Cycle Coding Strategies and our clients have enjoyed many webinars and previous podcasts by this team of experts. Melody joins us to address a current hot topic, “AUC – Delayed but not Gone.” 2022 was scheduled to be the official implementation date for AUC/CDS implementation but the 2022 Proposed Rule threw everyone a little curve ball. While a delay has occurred, it does not change the direction of the program or the need to prepare and test. As providers continue to either prepare their own practices or bridge the gap with imaging facilities, it is important that everyone be on the same page throughout the CMS implementation and remaining testing period.
Melody W. Mulaik, MSHS, FAHRA, CRA, RCC, RCC-IR, CPC, CPC-H is the President of Revenue Cycle Coding Strategies LLC and our presenter. Every organization needs to ensure correct coding and billing practices to optimize appropriate reimbursement and adhere to payer and CMS guidelines. Whether the providers are responsible for coding or the organization employs coding professionals there are steps every organization should take to ensure correct processes. This session will break down the key areas of concern and provide realistic solutions to efficiently and effective validate current processes and identify areas of potential concern.
Cindy Groux, CHBME/Board Member at HBMA and CEO, President and Owner of Health Care Practice Management, will address new CPT codes for 2021 to include prolonged services and clinical staff services, documentation changes to reduce the administrative burden, decreased needs for audits and how to promote coding consistency, and new rules for time billing.
Catherine Short speaks with Trey Scott, Coordinating Attorney for Kennedy, Attorneys & Counselors at Law located in Dallas, TX. The topic of today’s program is “Steering Clear of Legal Liability.” The discussion will help the audience navigate the choppy waters of potential legal actions that often arise in the world of healthcare. We will start with a basic overview of the typical steps leading up to the filing of a lawsuit. Listeners will also learn how to prepare for potential future litigation, and how to avoid simple mistakes that can later prove costly in a lawsuit.
Catherine Short speaks with Courtney Tito, Esq., Member of the Health Law group at McDonald Hopkins, LLC in its West Palm Beach office about “Payor Disputes and Audits: Observations & Strategies.” Our discussion will help listeners better understand the payor audit process and prepare the organization to respond. We will talk about the payor audit process from the government perspective and compare and contrast typical government audits with typical commercial audits. Finally, we will identify some best practices that providers can implement now to prepare for payor audits.