Thirty Coding, Billing, and Auditing Gray Areas

Pre Recorded

  • 60 minutes

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 the majority of coders, billers, and providers are taught.

Join this session by expert speaker Jeffrey, where he will 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.”

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.

Session Highlights:

  • A list of the 30 gray-areas in Coding, Compliance, Billing and Auditing

  • A discussion of each topic.

  • The 50% Rule

  • You will learn why a definitive “Yes” or “No” answer to most of the gray areas is unacceptable.

  • Why percentage of risk is a better measure than auditing as simply “correct” or “incorrect.”

  • Top misconceptions regarding “red flags.”

  • Confusion with Coding Modifiers

  • Confusion with modifier -25.

  • Confusion of the 2 of 3 Rule (E & M)

  • Confusion over level V E & M codes.

  • Advanced issues: Medical Necessity and Cloning Below is the current list of 30. I would not include all 30 in marketing literature but you can pick those you feel will help sell the Webinar:

  • 50% Auditing Rule

  • The Red Flag

  • Confusion over Modifiers

  • Chief complaint

  • 2 of 3 rule

  • Level 5 Encounters

  • Medical Decision Making (MDM) and Scoring

  • Medical Necessity

  • Professional-Courtesy Waivers

  • Cloning in EHRS

Why You Should Attend:

The majority of coding and billing seminars assume that there is simple answer to your coding and billing problems. This Webinar will explain using the “50-percent rule” those areas where there is most disagreement and confusion. Some coding rules and guidelines are nearly universal: NCCI edits, the 1997 E & M guidelines, The 14 ROS elements; others like Medical Decision Making, the 2 of 3 rules, and Medical Necessity–are much more complicated and subjective. You will find enormous disagreement.

Who Should Attend:

  • Family practice

  • Primary care

  • Internal medicine

  • Managers

  • Providers

  • Auditors

  • Compliance officers

  • Coders and billers

  • All medical professionals. This Webinar is not specialty-specific.

*You may ask your Question directly to our expert during the Q&A session.

** You can buy On-Demand and view it as per your convenience.

Jeffrey Restuccio

Jeffrey Restuccio

Jeff is a resident of Memphis, TN since 1980. He has two coding certifications: the Academy of Professional Coders (AAPC) certified professional coder for physician (outpatient) reimbursement and the AAPC certified professional coder for hospital (inpatient) reimbursement.

Jeff has been a certified coder since 1999. Jeff has the unique combination of over twenty years of experience, Medical Coding Certification (CPC & COC), training experience (medical coding and billing) a strong background in databases and Information Systems, and an MBA in Finance. Jeff is an experienced educator and auditor, having conducted over 365 live training courses, worldwide on CPT and ICD-10 coding and billing. He is currently teaching coding and billing Webinars for numerous companies. Jeff has personally audited over 10,000 medical records. Over his career he has instructed thousands of doctors, coders and billers through the website.

Jeff’s focus is on coding and billing training, both online and onsite and chart audits for Optometry and Ophthalmology. Jeff has worked with hundreds of clinics as well as professional associations and optometry schools.

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