August 3, 2023

Compliance with CMS’s Regulatory Language: It’s Not Always Black and White

The never-ending discussion between healthcare providers and the Centers for Medicare & Medicaid Services (CMS) regarding the interpretation and true intent of regulatory mandates can be frustrating for both providers and CMS. Despite the fact that some regulatory language has not changed for years, it is often the source of ongoing discussion, debate, and re-interpretation, all for the sake of clarity and to assist providers in their desire to comply. The issue is exacerbated every year…

Evaluation and Management Changes for 2023

The American Medical Association (AMA) announced revisions/changes that will affect Evaluation and Management (E/M) guidelines for hospital inpatient, observation, consultations, emergency department visits, nursing facility services, and prolonged care effective January 1, 2023. Finally, all evaluation and management services guidelines will align and will have the same set of requirements to level a service. We will no longer need to manage two sets of documentation guidelines. Summary of the E/M changes for 2023 Consultations – Deleting…

Claim Denials: Steps to Writing an Effective Appeal Letter

Writing an effective appeal letter to contest a denied claim involves time, effort and perseverance. The strategic approach of formulating the appeal letter requires a clear understanding of why the claim was rejected. The reason for the denial is the starting point. Considering this, thoroughly review the medical record within the denied claim period and tab the documents needed to support the claim. The Body of the Appeal Letter Begin the appeal letter with the patient’s…