Thirty Coding, Billing, And Auditing Gray Areas

Why Should You Attend:

This Webinar explains that despite what the AMA, AAPC, and most consultants want you to believe there are numerous gray areas in coding and auditing where this is considerable disagreement and no one good answer! Instead of auditing records or an issue as either correct or incorrect it’s better to assign a confidence or risk percentage. What percentage of auditors would rule this as passing versus failing? In many cases, it’s 50/50! That is not what most coders, billers, and providers are taught.

Another common error is advice from a consultant who has worked in a particular clinic in a particular city–and erroneously assumes that all 12 Medicare Jurisdictions and all 50 Blue Cross/Blue Shield carriers follow the same rules; they don’t.

Add to the mix that any carrier can determine their own rules or guidelines and you will realize why everyone is so confused. Yes, you always start with the AMA CPT definitions, explanations and scenarios; you then use whatever Medicare has to say on the topic, but after that, any carrier can contradict or ignore both CPT and Medicare guidelines. Some carriers, most notably local Medicaid carriers are notorious for creating their own rules that contradict coding standards and norms.

This webinar teaches you how to embrace the uncertainty and work with it–and how to avoid the pitfalls of assuming that everything is either “correct” or “incorrect.”

The result of this Webinar is for every organization to discuss the “gray areas” and decide how they are going to treat every issue. Ignoring them won’t make the problem go away. This discussion should be part of your internal auditing guidelines and your formal coding compliance plan.

Areas Covered in the Webinar:

1. A list of the 30 gray-areas in Coding, Compliance, Billing and Auditing
2. A discussion of each topic.
3. The 50% Rule
4. You will learn why a definitive “Yes” or “No” answer to most of the gray areas is unacceptable.
5. Why percentage of risk is a better measure than auditing as simply “correct” or “incorrect.”
6. Top misconceptions regarding “red flags.”
7. Confusion with Coding Modifiers
8. Confusion with modifier -25.
9. Confusion of the 2 of 3 Rule (E & M)
10. Confusion over level V E & M codes.
11. Advanced issues: Medical Necessity and Cloning
12. Your Questions

Who Will Benefit:

Managers, Providers, auditors, compliance officers, coders, and billers.

This Webinar is recommended for all managers, providers, coders and billers. It is an advanced webinar and assumes your staff understands the coding and billing basics and has had at least eight-hours of formal coding and billing training.

Jeffrey Restuccio
Owner, Ritecode and EyeCodingForum

Jeffrey Restuccio is the principal owner of Ritecode.com, a healthcare consulting company specializing in online training, live seminars, webinars, chart audits, and specialty consulting. Jeff is certified as both a CPC and a CPC-H from the Academy of Professional Coders (AAPC).

Jeff is an experienced educator and conducts training courses on CPT and ICD-9 coding and billing, auditing and compliance and has taught hundreds of live coding and billing seminars nationwide. He has audited over 10,000 medical records Jeff teaches specialty seminars on topic such as carrier-specific rules, medical decision making, auditing, compliance plans and winning appeals. His clients include Hospital Corporation of America, Hospital Management Association, St Jude Children’s hospital, the VA, DOD. and hundreds of small practices.

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