August 3, 2023

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…

Will Your Therapy Documentation Survive an Audit?

In 2020 there was a lull in Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) requesting medical records for audits through August 2020. Audits have resumed, including audits under the Targeted, Probe, and Educate (TPE) process. The most recent TPE focus involves Medicare Part B review of therapy claims billing CPT codes 97530 (therapeutic activities) and 97110 (therapeutic exercises) and Medicare Part A skilled nursing claims from 2017 through 2019 with admitting diagnoses of…