Life as a Coder: Recent Episodes
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In today's episode, we have a captivating discussion about a groundbreaking book that turns our understanding of healthcare as we know it today.
Joining us is the esteemed Dr. Henry Buchwald, a seasoned healthcare professional who has witnessed the transformation of healthcare over the past 50 years. Drawing from his vast experience and keen observations, Dr. Buchwald offers a unique perspective on the current state of healthcare in the United States.
Dr. Buchwald unveils a startling truth—that our healthcare system has strayed from its core purpose of prioritizing patient well-being. Instead, it seems to cater more to administrators and bureaucracy, resulting in an expensive and impersonal system that may not truly serve the best interests of the nation or its people.
Dr. Buchwald fearlessly addresses the broken doctor-patient relationship and explores the profound effects of pandemics like COVID-19 on our healthcare system. He leaves us with his vision for the future and the areas where he believes our healthcare efforts should be focused.
Prepare to have your perspectives challenged and your curiosity ignited as we venture into the world of "Healthcare Upside Down" with Dr. Henry Buchwald. So, grab a cup of coffee, sit back, and get ready to reexamine what you thought you knew about healthcare
Grab a copy of this transformative masterpiece Now by visiting https://www.amazon.com/Healthcare-Upside-Down-Critical-Examination/dp/303107162X
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In this episode we delve into the critical issue of healthcare cybersecurity and its increasingly vital role in protecting sensitive patient data. As digital transformation accelerates within the healthcare industry, the risks and challenges associated with cybersecurity have become more pronounced.
Join our expert guest, Britton Burton with Corl Technologies. Britton is a cybersecurity specialist in the healthcare sector. He shares invaluable insights and practical advice on fortifying healthcare systems against cyber threats. Britton brings a wealth of experience in safeguarding patient privacy, mitigating vulnerabilities, and implementing effective cybersecurity strategies.
During this engaging conversation, we explore the evolving landscape of healthcare cybersecurity, highlighting the following key topics:
- The Current Threat Landscape
- Emerging Cybersecurity Technologies
- Best Practices for Healthcare Organizations
- The Human Factor
Join us for this eye-opening episode as we unpack the challenges and opportunities within healthcare cybersecurity and discover practical strategies to safeguard patient data and maintain trust in the digital era.
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In this captivating episode, we delve into the realm of digital transformation in healthcare and explore its profound impact on patient care. Our expert guest in digital transformation Unmesh Srivastava, will shed light on various facets of this transformation, including the adoption of value-based care, harnessing the power of AI technology, and the crucial aspect of cultural sensitivity.
Join us as we uncover how healthcare providers are redefining their practices to prioritize value-based care. Discover how value-based care not only improves patient satisfaction but also enhances overall health outcomes while reducing costs.
We then delve into the vast potential of AI technology in revolutionizing healthcare. We will discuss cutting-edge applications, such as predictive analytics, machine learning, and natural language processing, which are transforming the way healthcare is delivered. Learn how AI-powered systems can streamline diagnosis, personalize treatment plans, and optimize resource allocation, ultimately leading to improved patient care and more efficient healthcare workflows.
But amidst the rapid technological advancements, our discussion takes a thoughtful turn towards cultural sensitivity in healthcare. We explore the importance of recognizing and respecting diverse cultural backgrounds, beliefs, and practices in the context of patient care. Our guests highlight the need for healthcare organizations to foster cultural competence, train their staff, and leverage technology to bridge cultural gaps, ensuring equitable and inclusive healthcare for all.
Learn more about what Clever Healthcare is doing to advance digital transformation in healthcare.
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This episode will discuss how to build meaningful relationships with patients, caregivers, and healthcare professionals. You will learn to build strong relationships with your teams, peers and external stakeholders. We will provide insights on how to build and maintain relationships that are beneficial to the organization as a whole. We will interview Jennifer Krippner Chief Experience Officer at the Institute for Healthcare Excellence Developing trust, communication, accountability, feedback and teamwork. Impacts that health care organizations have on the broader community, which will help leaders better understand the big picture. Valuable lessons that will equip and empower leaders to improve their relationships.Guest Jennifer KrippnerChief Experience OfficerThe Institute for Healthcare ExcellenceJennifer Krippner is a leading expert on patient experience and relationship centered care. Jennifer has more than 20 years of expertise in strategic planning, patient experience, physician development and employee/community engagement. Prior to her lead role at The Institute for Healthcare Excellence, she was director of physician development and guest relations at Maple Grove Hospital in Minnesota. While there, she led staff-driven patient experience advisory teams and developed projects that directly contributed to consistent top tier performance in key patient and staff satisfaction results.--- Send in a voice message: https://podcasters.spotify.com/pod/show/healthcrossroads/messageSupport this podcast: https://podcasters.spotify.com/pod/show/healthcrossroads/support
In this podcast episode, we sit down with Joey Dizenhouse, an expert in the pharmacy benefit management (PBM) . We explore the latest data trends in the PBM market, including rising healthcare costs. We also delve into the growing importance of data analytics and technology in managing pharmacy benefits and improving patient outcomes.Throughout the episode, Joey shares his experiences and observations from his work in the PBM industry and as a patient advocate, offering valuable insights into the challenges and opportunities facing patients, providers, and PBMs in today's rapidly evolving healthcare landscape. Whether you're a healthcare professional, patient, or simply interested in the latest trends and developments in the pharmacy benefit management industry, this podcast episode is a must-listen.Rising Healthcare Costs Growing importance of data tracking for improved patient outcomes Benefits and Challenges of Increased use of technologyFocus on patient engagementImpact and lessons learned since Covid19Patient Advocacy and Copay Assistance Programs Ale.desjean@healthtrustpg.com and todd.devree@healthtrustpg.comhttps://healthtrustpg.com/thesource/candid-conversations/inflation-reduction-act/https://healthtrustpg.com/ihp/human-capital/--- Send in a voice message: https://podcasters.spotify.com/pod/show/healthcrossroads/messageSupport this podcast: https://podcasters.spotify.com/pod/show/healthcrossroads/support
In this episode, we are showing our support for primary care physicians and how we can help them improve documentation.
Primary care physicians are the backbone of our healthcare system. They provide comprehensive health care services to patients and serve as the first line of defense against illness and disease.
Unfortunately, primary care physicians often struggle to keep up with the mountain of documentation requirements required which means that their time spent with patients is diminished, resulting in less efficient patient care.
That’s why we are here today, to discuss ways that primary care physicians can improve their documentation without sacrificing the quality of their patient care.
We will chat with our special guest, national speaker, and risk adjustment expert Christine Hall CHC (AAPC Instructor) CPC , CPB, CPMA, CRC, CEMC, CPC-I
Let's break down HCC and documentation areas of concern to improve efficiency, and calculation of true patient risk and help improve the quality of care.
- Direct Supervision and Telehealth post-PHE
- What is extended until 2024?
- Proper telehealth communication post-PHE
- Documentation that supports clinical indicators
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The documentation of the chief complaint is a crucial part of a patient's medical record. The chief complaint is the primary reason a patient seeks medical attention, and it is important to document it accurately to ensure proper diagnosis and treatment. In this episode, we will discuss
- Documentation vs Guidelines
- What the payers are saying
There is a level of critical thinking needed by coders and auditors. Our advisors will discuss these areas in detailLet's tune in to our advisors
Jennifer McNamara CCS,CPC,CDEO,CPMA,CRC,CGSC,COPC AAPC Approved InstructorEmail Jennifer at jmcnamara@oncospark.comVisit her website: https://www.sparkadvise.comHear her speak at RevCycle Symposium and AAPC HealthconTerry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPMEmail Terry at terryfletchercpc@aol.comVisit her website: http://www.terryfletcher.net/Christine Hall CHC(AAPC Instructor) CPC,CPB,CPMA,CRC,CEMC,CPC-IEmail Christine at christine.hall.guru@gmail.comVisit her website: https://www.stirlingglobalsolutions.com/Hear her speak at various Oncospark ConferencesBetty Hovey, BSHAM CCS-P CDIP CPC COC CPMA CPCD CPB CPCI
Email Betty at bettyhovey@chcs.consultingVisit her website: https://chcs.consulting/Follow Betty to a location near you: https://chcs.consulting/events/Sonal Patel, BA, CPMA, CPC, CMC, ICDCMEmail Sonal at paintthemedicalpicturepodcast@gmail.com
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In this episode, we are joined by our friend Glenn Krauss from CORE-CDI. Glenn and I had the opportunity to sit down and review the CDI programs for Inpatient and Outpatient and how important CDI is to the healthcare industry. We will discuss the following:
- The medical record as a communication tool versus a reimbursement tool
- Physician documentation improvement must be physician-centric and physician driven
- Compliance and ethics in Physician Documentation Improvement must be an integral part of any program
- Can CDI programs elevate compliance risk unknowingly without proper precautions being taken?
Find Glenn at the upcoming Pain Management Compliance Symposium on April 13 and CDI Symposium 2023 on September 13-14
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In the second installment of our series on Evaluation and Management, we dive into the importance of two keys areas
- Prescription Drug Management
- Major vs Minor surgery
There is a level of critical thinking needed by coders and auditors. Our advisors will discuss these areas in detail
Let's tune in to our advisors
Jennifer McNamara CCS,CPC,CPMA,CRC,CGSC,COPC AAPC Approved Instructor
- Email Jennifer at jmcnamara@oncospark.com
- Visit her website: https://www.sparkadvise.com
- Hear her speak at RevCycle Symposium and AAPC Healthcon
Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM
- Email Terry at terryfletchercpc@aol.com
- Visit her website: http://www.terryfletcher.net/
Christine Hall CHC(AAPC Instructor) CPC,CPB,CPMA,CRC,CEMC,CPC-I
- Email Christine at christine.hall.guru@gmail.com
- Visit her website: https://www.stirlingglobalsolutions.com/
- Hear her speak at RevCycle Symposium
Betty Hovey, BSHAM CCS-P CDIP CPC COC CPMA CPCD CPB CPCI
- Email Betty at bettyhovey@chcs.consulting
- Visit her website: https://chcs.consulting/
- Follow Betty to a location near you: https://chcs.consulting/events/
Sonal Patel, BA, CPMA, CPC, CMC, ICDCM
- Email Sonal at paintthemedicalpicturepodcast@gmail.com
- She is speaking @1pm EST on February 20 and 21, 2023 at Assent Global on Auditing in 2023
Part I: Focus on New E/M Standards in the Office/Outpatient Setting; and Auditing in 2023
Part II: Focus on New E/M Standards in the Inpatient Setting, respectively.
- She has a weekly Compliance & Auditing Tip for NAMAS® on 2/23/2023 titled, Dawning of a New Era: The Sun Rises on New E/M Standards in 2023 and Beyond.
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The world of healthcare is in a state of chaos. With the rising costs of medical care, the increasing complexity of healthcare systems, and the changing landscape of insurance and payment options, it can be difficult for patients and providers to navigate the system. While there are some efforts to organize healthcare chaos, there is still much work to be done.
In this episode, we sit down with Healthcare data and expert Jordan Johnson, MSHA, iMPaCT to discuss:
- Staff Shortages
- ️SDOH
- ️Population Health
- ️Coding and Billing Challenges
Learn more at the RevCycle Symposium on Feb 23, 2023
Grab Tickets HERE
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In this exciting three-part series we will hear from our advisors all about how to unravel the E/M guidelines and how to interpret areas of documentation. In this episode, we will look at how to interpret some key definitions in the MDM that affect a patient's condition.
- The meaning of acute vs chronic
- Exacerbated conditions vs severe exacerbations
- Complicated vs uncomplicated conditions
There are many areas to dissect and you simply cannot do it without research, communication, and a good understanding of anatomy and disease processes. .
Let's tune in to our advisors
Jennifer McNamara CCS,CPC,CPMA,CRC,CGSC,COPC AAPC Approved Instructor
- Email Jennifer at jmcnamara@oncospark.com
- Visit her website: https://www.sparkadvise.com
- Hear her speak at RevCycle Symposium and AAPC Healthcon
Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM
- Email Terry at terryfletchercpc@aol.com
- Visit her website: http://www.terryfletcher.net/
Christine Hall CHC(AAPC Instructor) CPC,CPB,CPMA,CRC,CEMC,CPC-I
- Email Christine at christine.hall.guru@gmail.com
- Visit her website: https://www.stirlingglobalsolutions.com/
- Hear her speak at RevCycle Symposium
Betty Hovey, BSHAM CCS-P CDIP CPC COC CPMA CPCD CPB CPCI
- Email Betty at bettyhovey@chcs.consulting
- Visit her website: https://chcs.consulting/
- Follow Betty to a location near you: https://chcs.consulting/events/
Sonal Patel, BA, CPMA, CPC, CMC, ICDCM
- Email Sonal at paintthemedicalpicturepodcast@gmail.com
- She is speaking @1pm EST on February 20 and 21, 2023 at Assent Global on Auditing in 2023
Part I: Focus on New E/M Standards in the Office/Outpatient Setting; and Auditing in 2023
Part II: Focus on New E/M Standards in the Inpatient Setting, respectively.
- She has a weekly Compliance & Auditing Tip for NAMAS® on 2/23/2023 titled, Dawning of a New Era: The Sun Rises on New E/M Standards in 2023 and Beyond.
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In our first episode of Season two, we start out with a very important topic that affects all in healthcare-Compliance! It's more than understanding what it is, but also how we view it and how we navigate the many levels.
Today we sit down and chat with Compliance and Legal expert Susan Walberg JD, a consultant, and writer in all things compliance.
Susan will tell us all about her latest Compliance Books and Non-Fiction books that are designed to shed light on meeting industry standards and navigating the legal minefields in healthcare. We will discuss
- What compliance is and why we need it
- Areas of Compliance concern
- Better communication skills are needed between clinical and business teams
- Compliance hot topics such s Privacy/Security and OSHA
- Compliance and Technology concerns
Prepare your practice and facility for compliance challenges and jump over to Amazon to check out all things Compliance with Susan Walberg:
Susan Walberg Books on Amazon
Insiders Guide to Compliance for Physician Practices Paperback – November 28, 2019
Insider's Guide to Compliance: Real World Advice for Building a Successful Compliance Program Paperback – February 20, 2018
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In this final episode of 2022, we are bringing back a fan favorite and a very important topic. We must continue advocating for improved access to care, a better quality of care, and better patient rights and protections.We sat down with Jared Walker the Founder of Dollar For and we dig into the importance of hospitals being transparent about their charity programs and empowering patients to take control of their healthcareDollar For is a program that provides financial assistance to individuals advocating for themselves or their loved ones in the healthcare system. Dollar For offers financial assistance to help cover the cost of medical bills, medications, and other expenses associated with medical bills. The program also provides resources and support to help individuals navigate the healthcare system and make informed decisions. Learn how you can help others by volunteering and becoming a patient advocateVolunteer as a Patient Advocate at https://dollarfor.org/get-involved/Apply for assistance at https://forms.dollarfor.org/Do you need education for your facility on how to improve your patient advocacy and improving in your billing and communication process? Sign up for the Rev Cycle Symposium to be held virtually on Feb 23, 2023 Tickets are on Sale Now! Visit https://www.eventbrite.com/e/revcycle-symposium-tickets-482774289897--- Send in a voice message: https://anchor.fm/healthcrossroads/message
Do you communicate effectively with your patients? Is your business staff up to the challenge of the necessary communication needed to keep your patients happy?
Let's chat about necessary conversations that require communication
- Explaining Financial responsibility
- Communication regarding Prior Authorizations
- Effectively communicating prior to the patient appointment
Legal requirements for Copays
Join us fo the RevCycle Symposium February 23, 2023 Online and On Demand
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In this episode I had the privilege of interviewing my friend Dr. Michael Cross.
Conversation with a Surgeon: Does your patient come first?
-Unique challenges in Breast Oncology
-Burdens physicians face
-Communication with teams
-Patient education
-Preventative measures and cost
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In this episode we discuss Diabetes. November is Diabetes awareness month and we want to understand the impact on patient care and reimbursement and the cost of treating the condition.
- How Diabetes affects Cost in Value-Based Care
- ICD10-CM Coding Guidelines
- Documentation and Risk
Learn more by scheduling an onsite review and education session with your physicians - Contact our Advisory Network
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We have a bonus episode this week, to take a look at how we portray ourselves on Linkedin. Do we understand the proper etiquette? Have we made our profile attractive to a future or current employer? Let's take a break and get Linkedin Savvy!
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In this episode we discuss the importance developing a Value Based Care Mindset. What can we do to improve in documentation in light of the new EM Revisions for 2023 that now encompasses Hospital Charges? Do we understand basic definitions and how they will affect Value Based Care payments? Do we understand basic documentation guidelines? Contact jmcnamara@oncospark.com to schedule your physicians annual Value Based Care training.
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In this episode I invite my special guest Christine Hall CHC (AAPC Instructor) CPC , CPB, CPMA, CRC, CEMC, CPC-I to discuss the Global Package. We will discuss the proposed revisions by CMS and the history of it since 1992. Are we ready for a revision? Let's find out
- What changes have technology and advances in medicine brought us?
- Are you getting involved and sharing what challenges your practice is facing?
- Specialty Specific Global Care for Orthopedics and Dermatology
- Is your EMR up the challenge?
- Using Subject Matter experts to improve operations and discover missed opportunities costing your practice
- Could revising the global package lead to better patient care?
Check out some great resources:
Global Package FAQ
Global Surgery Indicators
RAND Report
CMS-1751-F
Contact jmcnamara@oncospark.com for more information on improving your operations with coding and revenue challenges
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In this episode, we sit down with my friend and fellow podcaster Terry Fletcher and discuss the relationship between Physicians and coders. This is a significant relationship that helps utilize both the clinical and business sides of medicine. This partnership ensures compliance, and accurate revenue and allows the physician to focus on patient care while enabling the coder to make sure the revenue is solid. When physicians keep their hard-earned income, the practice can flourish and patients can continue to receive services. Terry and I will discuss:
- Expectations of Physicians and Coders
- Eliminating communication gaps with the assistance of Practice Management
- Having difficult conversations with physicians
- How consultants have become effective educators
Increase your revenue and decrease denials with an effective denial management program that consists of Data Reviews, Audits, and Education with Oncospark! Contact jmcnamara@oncospark.com for more information.
Check out more episodes from our special guest Terry Fletcher at the CodeCast Podcast on Apple, Spotify, Google, and many more platforms
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Are you feeling burdened down with the Prior Authorization processes? You are not alone.
In this episode we will chat with Manish Jain, Co-Founder and VP, Business Development of Oncospark and get his insights. We will answer:
- Why do insurance companies require authorization?
- Are internal process issues delaying treatment?
- Tips for organization, demographic errors, treatment changes and miscommunication in scheduling vs approval
- Can you truly automate the authorization process?
We will look at different kinds of authorizations such as:
Medication
Infusion
Surgery
Diagnostic testing
Check out www.authparency.com to augment your process.
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Join me and special guest Betty Hovey, BSHAM CCS-P CDIP CPC COC CPMA CPCD CPB CPCI as we look at "Behind the curtain with an Auditor"
- What is behind more audits in 2022?
- What does a lack of Audits say about your organization?
- Is Compliance your priority?
- What does an Auditor do?
- Why are Auditors vital in Healthcare?
Schedule your next audit by emailing jmcnamara@oncospark.com
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Check out me with my friend Pam Vanderbilt as we talk about Medicare and Modifiers.
We will discuss the MPFS Indicators and why all in the Revenue Cycle need to know how Medicare processes claims, because Guess What?
"Coding can change based on these Indicators"
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Join me and my special guest Leslie Boles, BA, CCS, CPC, CPMA, CHC, CPC-I, CRCas we discuss the shift that needs to happen in the Business of Healthcare. As the Co-Owner & President at Revu Healthcare Leslie and her team offer comprehensive regulatory compliance solutions to healthcare providers, hospitals, health systems, physician groups, and other healthcare entities.
In the past 10-15 years there has been a progression of gaps in communication between physicians and coders. Has technology played a role? What happened to good old-fashioned educated conversations? Do your coders and billers have access to the Physicians and Clinicians in your practice? We will also look at what Physicians are facing and how we can help them succeed.
- Burdens physicians face in patient care
- What can we do to be their advocate?
- Compliance issues we have seen in the documentation before and during PHE
- How administrators can bridge the gap between coders and billers and encourage open communication
- Do you know your EMR?
Technology tools enhance a successful practice and do not do all the work
Check out Code Interceptor Video and visit Oncospark to see all their technology solutions that may be the solution for your practice or facility.
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This week we dive into the Revenue Cycle as it relates to Medical Coding. We encourage all to think about how their role as a Medical Coder is a peice of that Cycle and how we approach that role will effect all members of a Healthcare facility. Ultimately it effects the patient. Do you know you are more than a Medical Coder?
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In this special episode I am joined by my friend Barbara Cobuzzi MBA CPC COC CPC-P CPC-I CPCO CENTC CMCS. We will catch up with her and see what she's been up to.
We will break down the Global Package for ENT Services and discuss
- Common issues in ENT Audits
- Endoscopic Sinus Surgeries
- Modifier 58 vs 78
- Appropriate use of Modifier 59 and CMS X(ESPU)
Contact her at http://crnhealthcare.com/
You will also want to check out our ENT Virtual Summit On Demand
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In this weeks episode we continue our discussion from last week and discuss the purpose of the Global Surgical Package. It is a lot to discuss so we will break it up into 2 episodes.
This week we will review:
- Modifier 57
- The Medicare Physician Fee Indicators
- What is Included in the Global Package Interpreting 0, 10 and 90 day Packages
- You can learn more about these modifiers as it relates to Orthopedic Services at our Upcoming Virtual Summit July 13-14 and earn 15 CEUS! Sign up today! Register Here
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In this weeks episode we are joined by Sonal Patel, CPMA, CPC, CMC, ICDCM. She is a repeat guest and we are very excited to discuss Modifier 25. It has been in the news lately and a very controversial Modifier for years now. We will discuss:
Modifier 25 Definition News from Commercial Payers OIG report from 2005 Using Authoritative Guidance
Check out these cool references: OIG Report CMS Global Booklet Fact Sheet CMS Processing Manual Check out the Podcast Paint the Medical Picture Check out our Upcoming Ortho-Care Virtual Summit where we dig into Using Modifier 25 for Orthopedics
This episode qualifies for a CEU for our All Patreon Squad Members. Become a member today at www.patreon.com/lifeasacoder
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We are on Vacation this week. Check out a replay of one of my favorite episodes with my dear friend Christine Hall
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In this episode we will chat with Jared Walker, Founder at Dollar For where the goal is Advocating for patients to eliminate medical debt. We are all patients at one point in our life. The Burdens to provide healthcare are great for providers and healthcare staff but the burden for patients are great indeed!
According to Jared " Many patients are involved in payment agreements and going into debt for medical bills they do not have to pay"
Let's discuss:
- Charity Care
- Patient Advocacy
- Medical Bill Education
- Being a proactive patient
Want to volunteer? Join NOW as a Volunteer and help Dollar For continue to #crush medical debt
Jared and I will both be speaking at the Healthcare Advocate Summit September 7-9 in New Orleans. Get your Tickets: https://www.healthcareadvocatesummit.com/
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We have a great Bonus Episode for everyone with my special guest Jessyka Burke. We discuss the ins and outs of Podiatry Billing and Coding Challenges.
- Routine Footcare
- NCCI
- Bunion Coding
- Hammertoe
- Know your LCD Policies
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In this episode we highlight why we are all here in the Business of Healthcare. To provide access to care for the patient population. It doesn’t matter what our role is, we have an obligation to fight for the patient so they can get what they need to improve their quality of life and in many cases save their life.
I had the privilege of speaking with two Healthcare Advocates and I am sharing that conversation with you all. Elizabeth Johnson and Melissa Paige join me today to talk about how they became Patient and Healthcare Advocates and how Healthcare Advocate Summit came about.
Learn more about our guests:
Elizabeth Johnson is the Chief Executive Officer for MedicoCX, a group of independent specialists unified by patient centric access to biologics in a timely and cost effective manner, as well as a co-founder and the President of NAMAPA, National Association of Medication Access & Patient Advocacy, Inc. Their goal is to empower healthcare advocates by providing a collaborative community focused on resources to navigate medication access and support.
Melissa Paige is the Co-Founder of HealthCare Advocate Summit, and the Co-Founder of NAMAPA. She is Recognized as an expert in patient access programs and navigation. She is a Prolific public speaker and educator. She uses her Leadership skills to oversee and coordinate process improvement projects that enhance business models and redesign workflows for improved efficiencies. Her passion for the patient and this drives her to break down access barriers and seek avenues for the highest quality care.
The Healthcare Advocate Summit is LIVE in person September 7-9 in New Orleans.
Grab your Tickets Today and support this very important event.
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In this week's episode I dig into the heart of getting your providers paid. Many of the breakdown starts with the data collected at the time of the appointment. In my career I started at the front desk. The most important role beside the Physician! I will walk you through my career from Receptionist to Consultant
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In this Bonus episode I am joined by Kimberly Clayson of Jaffe Raitt Heuer & Weiss as we give you a preview of the legal issues facing the industry and some insight into No surprise billing that she we give us at the Orthopedic Conference.
- What is No Surprise Billing?
- What it means for Orthopedics?
- Upcoming topics for the OrthoCare Summit
Join us and get your Tickets
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Welcome to Episode 1 of Season 6!
We are happy to invite our first guest of the Season Laurie Bouzarelos MHA,CPC on the show today to talk about Behavioral Health audits.
Laurie Bouzarelos, MHA, CPC is a health care consultant with a special interest in supporting the unique business needs of behavioral health practices. Laurie works with psychiatrists and behavioral health providers to improve practice revenue and address compliance shortfalls. Laurie helps providers understand their revenue and facilitates operational changes to meet managed care and government payer requirements and state and federal laws. Areas of focus include managed care contracting, documentation improvement, EHR templates, coding accuracy and medical billing.
We will discuss the recent OIG audit that was done in NY and what we can learn from it.
Read more
Our focus will be on the areas of:
- Treatment Plans
- Frequency
- Documentation
- Incident to requirements
- Time documentation
- Telehealth
- Know the OIG Workplan
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In todays episode we dive into LCD policies, Coverage and Evaluation and Management tips for Diagnosis Documentation. It is so important to understand the impact that Medical Necessity and Coverage guidelines play in reimbursement. Outside of direct care providers many patients rely on their insurance coverage to get the services they need. By accepting assignment on their behalf and submitting their claim we can aid them as professionals to continue getting these service and to be reimbursed the highest amount available. We can do this by understanding:
- Current Active LCD Policies
- Prior Authorization Criteria vs Coverage Guidelines
- Documenting Risk and conditions that effect the risk
- Timely Submission of accurate claims with supporting Documentation
Medicare Coverage Process
Patient LCD Disputes
LCD What's New Report
LCD Q/A
Diagnostic Colonoscopy LCD
Do not keep writing off claims for preventable Prior Authorization Denials. Get started with Authparency
Watch it in Action!
Earn a CEU for this Episode by becoming a Patreon Member
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In this Episode I welcome my colleague and Fellow Physician Educator Crystal Watters.
Remote vs Onsite jobs
Passing an exam doesn't guarantee a job
Social media ettiqite
True value of CEUS
Apprentice Credentials, do we need them?
What does having a credential tell a prospective employer?
Different Credentials
Earn a CEU for this episode by joining our All Access or VIP Membership www.patreon.com/lifeasacoder
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In this final episode of our 4 part series with Behavioral Health I wanted to close out with awareness of Stress and Anxiety awareness.
April is #stressawarenessmonth and we discuss the damage prolonged stress can have on our mental and physical health.
🔸️Stress and Anxiety Awareness
🔸️Final Rule and Behavioral Health
🔸️Exam Anxiety
Exam Anxiety Tips
Do not miss our Specialty Conference series! We have specialties:
- OBGYN
- Pediatrics
- Cardiology
- Oncology
- Orthopedics
Find out more at ozarkinstitute.oncospark.com
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Let's discuss the Clinical side of Personality Disorders. I have a special guest Paul Sheesley MA, LPC,LCPC,LCADCa clinical Psychotherapist and Consultant specializing in Personality disorders and Substance Abuse.
We will discuss:
- Personality Disorders
- Presentation of these disorders
- Effect on Family and Society
- Risks
- Early Detection
- Effect on Anxiety, Depression and Overall Health
Paul's Bio:
Paul Sheesley, is a mental health practitioner with almost 20 years of experience in the field of clinical psychology and human behavior. He equips high-powered professionals, prominent couples, and families committed to healthy interpersonal relationships with personalized support, tailored treatment, and necessary steps to regain a balanced self that positively impacts all areas of life.
Paul Sheesley, is an expert in the treatment of narcissism and borderline personality disorders and offers a specialized use of schema therapy in the treatment room. Schema Therapy is a systematic approach that draws on the cognitive-behavioral, attachment, psychodynamic, and emotion-focused traditions and conceptualizes patients who have personality disorders.
Located in Washington, DC and Maryland his practice is available to assist clients and loved ones experiencing personality, emotional, and behavioral challenges associated with such challenges common in BPD and NPD.
Check out our Amazing new Prior Authorization tool for Behavioral Health Services and many other service lines at www.Authparency.com
This Saturday we welcome our Industry Leaders and attendees to the Pediatric Summit where we will dig into some Behavioral Disorders for Pediatrics
Register Here
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In this episode I am joined by my colleague and friend Barbara Shaw, CPC, CPCO, CDEO, CRC, CEDC . W will discuss Risk adjustment and Social Determinants of health as it relates to Mental Health Services
- What is Risk Adjustment?
- Important reminders about SDOH
- Risk Adjustment Documentation
- Mental Health and SDOH
Join the Risk Adjustment Masterclass created by Risk Adjustment leaders and educators.
Ask us about our special programs for Hospital Employee education
This episode qualifies for 1 CEU for our Patreon Squad Members. Jump over to www.patreon.com/lifeasacoder
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In this episode we begin our four part series on the Behavioral Health Crisis. I will be sharing my thoughts on mental health in the workplace. I share what I have learned in my career and the things that have contributed to my professional growth.
We can all improve in our way of dealing with others at home and in the workplace.
- Mental Health in the workplace
- Communication between departments
- A Leader vs a Boss
- Growth opportunity suggestions
There will be CEUS offered for certain episodes. Please join the Patreon squad to support the show at www.patreon.com/lifeasacoder
Learn more about #authparency and schedule a Demo today! https://authparency.com/
You will also enjoy our April Webinar on Billing for BHI and telehealth during and after the PHE. Register HERE for your staff or for your facility.
Learn about Leadership
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In this Episode I'm joined by Sarah Ragan. A seasoned coder and auditor. She's a great educator and mentor. Today we talk about the benefits of Virtual Education and why it is a valuable way to get our education.
- Value of Education
- Virtual Education before and after the pandemic
- Benefits of Virtual Education on the community
- Networking Value
Learn more about our Virtual events HERE
Connect with Sarah Ragan, COC, CPC, CPMA, CRC, CFPC if you need a speaker for your next event! You can learn more about the opportunities to become a Certified Instructor HERE
Does your Organization need help streamlining your Prior Authorizations and increasing revenue while decreasing unnecessary denials? Visit authparency.com for your FREE Demo
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Join me and my special guest Stephanie Thebarge CPC, CPMA, CPPM, CPB, CEMC, CHONC, PESC talking about all things #Oncology
We discuss the differences in Surgical Oncology, Medical Oncology and Radiation Oncology.
We discuss the necessity of a proper understanding of Guidelines, Payer requirements and the natural desire to be a good reseacher. This specialty requires a desire to know all you can about how Oncology drugs happen and truly caring about the patients and being a #patientadvocate
Do not miss her #infusion presentation at #Healthcon22 "Breaking Down Billing for New Drugs" #session 3G
Learn more about #authparency at https://authparency.com/
You will not want to miss Hyperoncology Summit 2022!
- Medical Oncology Infusion Rita Genovese
- Radiation Oncology Jordan Johnson, MSHA, iMPaCT
- Surgical Oncology/CPT/ICD10-PCS Jennifer McNamara CPC,CCS,CRC,CPMA,CPC-I,CGSC,COPC
- Risk Adjustment Barbara Shaw, CPC, CPCO, CDEO, CRC, CEDC
- Evaluation and Management Betty Hovey, BSHAM CCS-P CDIP CPC COC CPMA CPCD CPB CPCI
Want to sponsor or sign up as a virtual exhibitor? Download our Prospectus
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In this Bonus Episode Kimberly Jolivette Williams CPC CPB CPMA CANPC CCC CEMC is my special guest. Its March Madness with Modifiers and we are here to talk about our favorite ones and some very important tips and guidance. *Always check your state and local plan websites for Modifier guidance
Why do we use modifiers? Modifier 24,25, and 57 Modifier 58,78,79 New F Modifiers Modifier TC,26 Modifier 50 and 59
Modifier List Medicare Proper Use of Modifiers 59 & –X{EPSU} OIG Modifier 25 OIG Modifier 59 CMS PHE Modifiers UHC Do not miss our upcoming Conferences that are Virtual, On demand and have CEUS! Visit our Conference Page Earn 1 CEU for becoming a All access or VIP member of the patreon squad at www.patreon.com/lifeasacoder
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In this episode we will be joined by our special guest Mia Reddick-Smith, PMP, MBA, CPC-I. She has over 16 years’ experience working in healthcare revenue integrity and project management with enterprise system implementations. She is a results-oriented professional leading development of reimbursement and charge capture programs as well as executing organizational operating and financial objectives.
Currently she teaches medical coding/billing AAPC® CPC prep courses. As someone with a vision of processes and workflow development, she has a comprehensive knowledge of the health care nomenclature and systems, along with capacity to manage healthcare technical projects/programs to develop strategic products.
We will sit down and discuss:
- Coding as a Profession
- Going from a Coder to Instructor
- Bridging the gap in departments for Billers and Coders
- Being successful in the CPC exam with our special tips
- Self study vs Results driven Instructor coaching
Connect with Mia
Get more Continuing education at our upcoming Specialty Virtual Conference series on Pediatrics April 16, LIVE and On Demand
Register Here
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In this Episode I invite back my friend and fellow Podcaster Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM. She is the host of the #codecast podcast. In our years working in the business of healthcare we have seen so much fraud, waste and abuse. Much of the waste is simply not understanding the appeals process. So much money is left on the table by needless Denials and decisions not to appeal. This is a #donotmiss episode
- CMS Appeals Process
- UHC Appeals Process
- Using ERISA Appeals Process
- Clerical Errors and Reopening
Become a Patreon Subscriber to get CEUS at www.patreon.com/lifeasacoder
Listen to the Codecast Podcast on your favorite podcast station Do not miss Terry and our Special Guests at the Virtual Cardiology Summit May 21-22. Learn More
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Join me and my Special Guest Jessyka Burke, BSHA, CPC, COSC, CASCCas we dive into the world of billing for Workers Compensation, Tricare and Auto Insurance Billing. We thought these are areas of Billing that often get misunderstood or billed incorrectly. It takes organization and constant follow up. We give you the tips to be successful.
- Getting organized
- Know state guidelines
- Different types of military insurance
- Challenges in getting visits approved with Tricare.
- Suggestions for Billing Auto claims
Tricare Breakdown Tool
Schedule a Demo of our Authparency Software Solution: https://authparency.com/
If your Orthopedic practice is 60-70% Workers comp you will want to listen to this episode and do not forget to Join Jessyka and I at our upcoming Ortho-Care Virtual Conference July 15-16
Buy Tickets
We have a special 10% off for our listeners with CODE ORTHO22
✔️ICD10-CM Guidelines for Orthopedics
✔️Documentation for 2021 E/M for Orthopedics
✔️ICD10- PCS for Musculoskeletal
✔️Fracture Care: Closed vs ORIF
✔️Arthroscopy: Shoulder, Knee, Ankle
✔️Total Joints
✔️Appeals and Denials
✔️Spine Coding
✔️Podiatry
✔️Hand and Wrist
✔️ASC Billing
✔️Pain Management
✔️DME
✔️Stay Legal with No Surprise Billing
✔️Office Procedures and Injections
✔️LIVE Giveaways
✔️Expert Speakers
✔️Virtual Networking
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Everyone has a role to play in the Revenue Cycle. Its important that we understand each other's role to work better as a team. Join Vanessa Moldovan and myself as we discuss:
- Overview of revenue cycle
- What is the difference in billing vs coding?
- Job responsibilities of a coder vs a biller
- What other roles in RCM can a coder be utilized in?
- Ways to improve communication
- Simple errors and how communication can improve these
CMS Status B Guidelines
OIG Coding Guidelines
Join our Virtual Conference Series to help educate your Coding and Billing staff Register Today
https://ozarkinstitute.oncospark.com/virtual-events/
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I get many questions about how to read and dissect an operative report. In an effort to answer some of those questions I have decided to talk about the process in this episode.
- Operative Report Elements
- Getting Organized
- Understanding the Medical Necessity
Learn more about Surgery coding for OBGYN Services at our conference Saturday 2/12/22
www.obgynsummit.com
Join our Annual Patreon membership to get CEUS for select episodes. www.patreon.com/lifeasacoder
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During the Public Health Emergency our world in the Business of Healthcare is constantly changing. One area we see constant movement in is Telehealth Services. Today my special guest Christine Hall and I will discuss this topic and some reminders on Coding based on the current IC10-CM Covid 19 Guidelines.
- What is the difference between Telehealth before and after the PHE?
- How can practices to be successful in making sure the claims get out to the right POS?
- For the Telehealth services there is a Telehealth Services List. How do we understand these different categories?
- What changes occurred in 2022 for Behavioral Health how will this benefit this service line?
- Under telehealth there are all these waivers and allowances. How can practices get organized and maneuver through all the changes?
- What are some reminders when reporting ICD10-CM Covid 19 based on the guidelines?
Official Guidelines for ICD10-CM 2022
COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing
Medicare FFS Response to the PHE on COVID-19
ACP Resources for Practices
Check out the Authparency Website http://authparency.com/
Watch a Demo
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I'm going to make E/M coding easy for you in 2022 and review how to use the official AMA®️ MDM Table to level your codes. Plus key areas of Strategy for your practice. There will be 1 a CEU for this bonus episode if you are an All Access or VIP member. Join the membership at www.patreon.com/lifeasacoder
CPT® is a registered trademark of AMA
- Work on your 2022 education plan
- Understanding 2021 guidelines before more changes occur in 2023
- Helping providers stay current with Internal and External Education
- PHE Waivers and allowances
- Using the right modifiers
- Tracking Denials
- Audit Strategy
Watch the Live Video to view the slides and comment with your questions: https://vimeo.com/662376984
Check out these cool references:
How to Use the MPFS Look-Up Tool
2021 AMA® Guidelines
Implementing CPT® Evaluation and Management (E/M) revisions
Check out the Authparency Website http://authparency.com/
Watch a Demo
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In our first episode of Season 5 we are hitting the ground running with a popular topic. Creating a Risk Adjustment Education experience for Coders and Facilities will be so valuable for the Industry and help improve the quality of patient care. The data we collect and the education we provide as Risk Adjustment educators and coders helps to accomplish this.
- How to improve your Risk Adjustment Team
- What does it take to discover the financial Impact of your Risk Adjustment program integrated through data solutions?
- How can a Risk Adjustment education program Reduce Coding Errors and ensure Complete code capture to account for proper reimbursements, manage costs of high-risk patient populations, and provide a high quality of care?
- What is the value in bringing in Subject Matter experts to educate Coding staff on Risk adjustment?
Check out the Authparency Website http://authparency.com/
Watch a Demo
Contact jmcnamara@oncospark.com for more information on our Upcoming Risk Adjustment Experience. Support us by joining our Podcast membership. You can save up to 16% off your membership by paying annually. Visit www.patreon.com/lifeasacoder
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There are many new changes to Orthopedic Coding in 2022. I will discuss those changes and how to be successful in reimbursement for these services. I will talk about the challenges I faced as a new coder and how I have been successful in Orthopedics.
- New 2022 Guideline revisions
- Fracture Care and Modifier 54
- New Spine codes for Laminectomy
- Understanding Fracture Care ICD10-CM Guidelines
- Understanding NCCI guidelines and PTP Edits
- Understand Modifier 25 in 2021 and beyond
Get a CEU if you are an All Access or VIP member
CPT® is a registered trademark of the AMA
NCCI Chapter 4a
AAOS on Fracture Care
Reference: CPT Changes 2022 AMA (C)
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Did you know that Copay collections are required when you enter into a contract with an Insurance payer and that Routine Waiver of copays is against many Federal laws and regulations Including the Civil Monetary Penalties Law (CMPL), Anti-Kickback Statute (AKS), and the False Claims Act?
Today we dive into the Laws and the regualtions so we can be compliant.
- What is a Copay?
- How to Understand Cost Sharing
- The Anti-Kickback Statute and Copays
- The False Claims Act
- QMB Status
Check out these great resources:
Why can Copay Waiving be Illegal?
UHC Administrative Guide
False Claims Act
OIG Special Fraud Alerts
Support the Show
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Today we will discuss the various guidelines for reporting diagnostic services, Radiology Documentation requirements and Common Modifiers
Objective:
Section IV of the Official ICD10-CM Guidelines
CMS IOM 100 Guidelines for Documentation
LCD Policies
Data Component of E/M Services Review
To earn a CEU for this Episode you must be a member of the Patreon Squad. You can join our Basic, All access or VIP memberships and get your Annual CEUS by listening to the show
Please see these helpful links mentioned in the podcast:
Breast Imaging LCD
Medicare Claim Processing Manual
2021 E/M Guidelines
Check out Ozark Institute Powered by Oncospark
Get CEUS for todays episode by becoming a Patreon
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Today we discuss the Maze of Provider Credentialing and Important reasons to Credential your Facility and Provider with an Insurance company.
Objective:
Using PECOS and CAQH
Importance of Payer Contract Negotiations
Updating Provider Enrollment
Inhouse or Outsourcing
Please see these helpful links mentioned in the podcast:
PECOS Enrollment Checklist
CAQH Proview Resources
UHC Credentialing Information
Understand No Surprise Billing
Is Balance Billing Legal?
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Do you struggle with EOB Language and Denial Codes? Do you know how to understand the NCCI Manual or how to use an Encoder? All of these things are crucial to understand as a coder or a biller. If you are a Office Manager or Physician you will also enjoy listening. Reach out to us if your clinic would like to look at our Data Analytic tools to streamline for practice flow and maximize payment
- EOB Breakdown
- Common Denial Codes
- Reviewing the NCCI Manual
- Be encoder Savvy
Learn from Industry leaders at our 2022 Virtual Conferences
Feb 12,2022 we come together with Experts Shannon Deconda CPC, CPC-I, CPMA, CEMC, CEMA, CMPM, CRTT and Betty Hovey BSHAM CCS-P IP CPC COC CPMA CPCD CPB CPC-I as we learn more about the Reimbursement challenges for OBGYN Services
Visit www.OBGYNsummit.com and check out our Upcoming events on Eventbrite
Earn a CEU if you are an All Access or VIP member at www.patreon.com/lifeasacoder
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Today I will be talking about my career path and how to navigate your career path in a similar way. I give you my take on the main Coding Certifying Industries AAPC® and AHIMA®. I am certified in both and I love them both for what they offer to help coders and billers. Lets discuss:
Options for CPC-A CPC or CCS? Other Career Options Technology and Coders Maintaining a positive attitude
To obtain a CEU for this episode please join our Patreon squad at www.patreon.com/lifeasacoder Check out our upcoming Conferences at Eventbrite Visit our website to sign up for our CPC Course starting 1/3/22 at www.cpccoder.org
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Listen to our Bonus Episode of Life as a Coder featuring the one and only Kimberly Jolivette Williams CPC CPB CPMA CANPC CCC CEMC as we discuss Maternity Billing and Anesthesia.
There will be 1 CEU available for All Access and VIP Patreon Squad members. Join at www.patreon.com/lifeasacoder
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Join me as I Interview Bettina Hein. Bettina Hein is a serial software entrepreneur that has built technology companies in both Europe and the United States. She is most recently the founder of digital health startup juli, her third software company. She is also the founder of Pixability, a video advertising company in Boston. Prior to Pixability, Bettina co-founded SVOX, the Swiss-based speech technology company which was acquired by Nuance Communications (NUAN) for $125 million. Bettina has received numerous awards and recognitions such as the 2018 Immigrant Entrepreneur of the Year Award, World Economic Forum Young Global Leader, L’Oreal NEXT Generation Award, and The Boston Business Journal’s “40 Under 40 Award.” Bettina holds an MS degree from MIT, a law degree from the University of Constance, and a business degree from the University of St. Gallen. Bettina holds two software patents and is the co-author of Video Marketing for Dummies. She is also a “shark” on the Swiss version of Shark Tank called “Höhle der Löwen Schweiz.” https://www.juli.co/
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Spinal Fusion coding can be complex especially if we do not understand Spinal Anatomy, Coding Guidelines and Payer Requirements. CMS and AMA can differ in their interpretation of documentation and bundling of Laminectomy and Arthrodesis. Do you understand all the elements of an Arthrodesis Procedure.
Lets Talk about it:
- Spine Anatomy
- Arthrodesis Components
- Bundled Procedures
- Co Surgery
- PCS Guidelines for Fusion
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Modifiers can be confusing since we have so many of them. There are CPT® modifiers and Payer specific ones to navigate through. Today we will focus in the most commonly used ones with the Global Package and how to know when to apply them We will pick on the 59 modifier and give examples of GI procedures that are commonly denied and how to interpret the 59 modifier or X Modifiers.
- Modifier Purpose
- Global Modifiers
- Surgery vs E/M Modifiers
- Modifier 59 and GI Denials
Helpful Links:
59 Modifier for GI CMS
Modifier 53 for Colonoscopy
NCCI Manual Chapter 6 Digestive CMS
Proper Use of Modifiers 59 & –X{EPSU}
Join our Upcoming Specialty Conferences and Events in 2022 on Eventbrite Earn CEUS for Listening and Become a Patreon Squad Member: www.patreon.com/lifeasacoder
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https://anchor.fm/jennifer-mcnamara8/message
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As a Coder or Biller it is very important that we all understand the proper use of our Coding Manuals as the improper use of them can impact claims payment and increase denials of we do not follow the guidelines. The more we understand the manual and how it can help us, the more efficient we can be. We will discuss:
Introduction Code Structure Symbols and Colors Appendices Section Tips No Surprise Billing and OON Negotiations
We have some helpful links below to help you navigate ICD10-CM 2022 Official Guidelines No Surprise Billing CMS
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In this episode we will talk about coding with Authority and the importance of using the right resources when we do research and when we educate physicians. We will also talk about some items to remember when coding for Orthopedic Services directly from our 2021 NCCI Manual from CMS.
- Know the Authoritative sources for coding and reimbursement
- Know when changes happen and keep up to date
- Getting to know the NCCI Manual Chapter 4
- Coding reminders for Arthroscopy and other reminders
Here are some helpful Link so you can do research on your own:
2021 NCCI Manual Chapter 4
E/M Services Guide CMS
Complying With Medical Record Documentation Requirements
Documentation Matters Toolkit
HCPCS Quarterly Updates
CMS Orthopedic ICD10-CM
Join us for our Upcoming Events on Eventbrite!
Register
Earn CEUS each month for upcoming episodes by becoming a patron:
www.patreon.com/lifeasacoder
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Learn the importance of Prior Authorizations and how to protect your practice revenue as well as help ensure your patients are taken care of. We will discuss: Common Pitfalls Need for Communication Written policies Staff education
Check out AuthParency for an amazing Tool and Platform to organize your Prior Authorizations
Contact me for more Info
Join us for our Upcoming Events on Eventbrite!
Register
Earn CEUS each month for upcoming episodes by becoming a patron:
www.patreon.com/lifeasacoder
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Ophthalmology and Optometry Coding and Billing has its own little niche that has many areas to be aware of: * Coding and Billing CPT/ICD10-CM * Injections * EM vs Ophthalmic Eye Codes * Surgical Coding Complexity * New Codes 2022 * Prior Auth * Cornea Transplant with ASC
E&M or Eye Codes? How to Choose Which to Use Eye Code Checklist
Coding Complex Cataract Surgery
Cornea Transplant Info
Glaucoma Coding for Stents
Diabetes ICD10-CM Decision Tree
Join us for Virtual Healthcare Summit 2021 this weekend 9/10-9/12/21 20+CEUS with 15 Industry Leaders:
www.ozarksummit2021.com Use code Welcome10 for 10% off
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We want to introduce our special Guest Betty Hovey Of Compliant Healthcare Solutions. She has over 30 years in the healthcare field, working with small and large facilities. Betty worked for Karen Zupko & Associates as a senior health care consultant performing audits; speaking at conferences; and providing onsite physician, coder, and other staff education. She also worked for AAPC as the Director of ICD-10 Education and Training. She co-authored manuals and presentations, held training sessions and gave presentations nationwide on ICD-10-CM and ICD-10-PCS. She also managed and educated the 45 ICD-10 expert trainers for AAPC.
She served as a member of the national advisory board for AAPC from 2004-2007 and was an officer on the board from 2005-2007. She is currently a Council member on the AHIMA national Council for Excellence in Education, a Board member on Quality MD, and Board member of the Editorial Board for BC Advantage.
We will Break down the 2021 Changes and how to use the Guidelines to interpret documentation.
● Data Section Interpretation
● Physician Education
● Risk Documentation
I also encourage you to follow her on Linkedin and Network with her:
Betty A Hovey, BSHAM, CCS-P, CDIP, CPC, COC, CPMA, CPCD, CPB, CPC-I
Visit her website: www.CHCS.consulting
Join her at Virtual Healthcare summit for her Discussion with me on CCS Exam preparation and CDI Integrity
Buy Tickets
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We will review the different areas of the Risk Adjustment Exam and how to network to get your first Risk Coding Job
Objective:
- How to Become a Remote Risk Adjustment Coder
- Different Risk Models
- Provider Documentation
- ICD10 Guidelines
Here are some helpful Link so you can do research on your own:
Medicare Risk Manual
AAPC Risk Exam Information
I also encourage you to follow me on Linkedin and Network with me:
Jennifer McNamara CPC,CRC,CPMA,CPC-I,CGSC,COPC AAPC Approved Instructor
Purchase our On Demand Risk Summit 2021
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Join the Patreon Squad and earn CEUS: www.patreon.com/lifeasacoder
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Let's learn the basic Structure of ICD10-PCS. It's so fun to code PCS. ● Root operations ● Approach ● Device and Qualifiers ● Examples Want to learn more? Join myself and Betty Hovey at Virtual Healthcare Summit 2021 September 10-12 and earn 20 CEUS
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In this episode we will break down the coding guidelines and discuss examples for Pacemaker and Defibrillator coding. We will also talk about the NCD/LCD policy for AICD and of course I will give you PCS coding tips. We will review the codes 36901-36909 and break down the guidelines JOIN Virtual Healthcare Summit 2021 September 10-12 with 20 CEUS This Episode qualifies for 1 CEU for our members so Become a Patron and earn CEUS Memberships
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In this episode I decided to Interview a Physician. Dr Hale Hedley is a Physician and Entrepreneur. Dr. Hale E. Hedley received an undergraduate degree in business with high honors from the University of Maryland. He went into the legal field as a graduate with honors from George Washington University School of Law. As a licensed attorney in Florida he worked at a large multi‐state law firm practicing business, litigation and property law. He maintains an active law license and works as a consultant for medical‐legal (defense primarily) cases and business startups.
To solidify his plan to practice medicine Dr. Hedley attended and graduated with honors from Georgetown University School of Medicine and went on to complete the University of Florida/Shands Jacksonville Emergency Medicine Residency Program. He maintains board certification from the American Board of Emergency Medicine and actively practices at a number of hospitals – primarily in southern Georgia and Florida. Besides the traditional workplace, Dr. Hedley has always engaged in entrepreneurial activity. He started a novel concept with online legal forms in 1997 – that is still around todayHe is part of a rapidly expanding online healthcare compliance system for small to medium sized healthcare concerns.
Join Dr Hedley at Virtual Healthcare Summit as he talks to us about Musculoskeletal Anatomy. Purchase tickets at www.ozarksummit2021.com
Get your compliance in check with Epi Compliance and take the headache out of your compliance process.Right now, Life as a Coder podcast listeners can save 20% on their subscription by visiting EPIcompliance.com/ozark and using the discount code OZARK20.
You work on your business, let EPICompliance take care of your compliance.
Help support us so we can keep making episodes and join the Life as a Coder squad at www.patreon.com/lifeasacoder
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We have our first Bonus episode talking about common coding areas that are misinterpreted for coding exams and common denials. Plus Join us as we dig into some new guidelines that are out now for 2022 and go into effect 10/1/2021.
Review:
● Vaccination vs Immunization
● Coding for Administration Components
● Coding Per Vaccine
● ICD10-CM 2022
● JOIN Virtual Healthcare Summit 2021 September 10-12 with 20 CEUS
References:
How to Code for Immunizations and Administration Commonly Administered Vaccines for Pediatrics
Vaccination FAQ
Official 2022 ICD10-CM Guidelines
CDC Vaccine Information
Become a All Access or VIP Patron and earn CEUS:
Memberships
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Let’s discuss the other areas of E/M that may have been forgotten by many in 2021. We have been overloaded with 2021 E/M guidelines but let's not forget those other important areas of E/M Guidelines.
TCM(Transitional Care Management)
AWV(Annual Wellness Visits)
Observation vs Inpatient Admission
Same Day Discharge
Two Midnight Rule and New RULE IPO Update
Split/Shared Guidelines
Here are some helpful Link so you can do research on your own:
Earn CEUS each month for upcoming episodes by becoming a patron:
www.patreon.com/lifeasacoder
Earn CEUS each month for upcoming episodes by becoming a patron:
www.patreon.com/lifeasacoder
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Many work from home and can be very productive. Some employers have concerns about moving to this platform
- What the Data shows
- Not all are cut out for Remote life
- Tips for remote working productivity
Please see these helpful links mentioned in the podcast:
Become a Patron and get MORE CEUS!
Working from Home Productivity Statistics
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Let’s do our 6 month Check up and see how we are doing with the New 2021 Guidelines
Review:
•Differences in Data Elements for each Level
•Provider Education
•Interpreting Minor and Major Surgery
•Chronic vs Acute
•SDOH
•Specialty Examples
This episode qualifies for 1 CEU!
Please submit Quiz to get CEU! This is FREE and future episodes with CEUS will require membership donations.
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Are you familiar with how to use LCD Policies?
Review:
•Using your MAC Carrier
•Provider Education
•Examples of what is in a Policy
•Coding Articles
Become a Patron and earn CEUS:
Memberships
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Are you creating a Culture of Compliance? Join me and my special guest Mr Jose Delgado of EPI Compliance. EPI has an excellent program and service to help practices and facilities create and maintain an effective compliance program.
We will Interview Mr Delgado and ask him these questions:
● What are the common areas you see in healthcare where compliance is lacking?
● What do healthcare facilities often misunderstand about compliance?
● Why do we need compliance?
● What makes for an effective compliance program?
● What are some basic steps facilities can take to create a welcome environment for compliance?
● How has EPI compliance been successful in creating a compliance culture with their clients ?
● What should clinics and facilities ask themselves when considering a compliance plan for their facility?
SPEAKER: Jose A. Delgado
Jose A. Delgado has a wealth of experience in business development, growth and management. For the last 20 years, Mr. Delgado has focused his experience in the hospitality, healthcare and finance industries. Jose possesses a natural love for debate, entrepreneurship, and a desire to innovate the healthcare and financial industries.
Drawing from the hospitality and industry, Mr. Delgado has brought in the importance of several facets of business that are traditionally overlooked like customer care/experience, human resources, business management, business culture, marketing and branding.
From healthcare, Mr. Delgado quickly realized that having a real understanding of Compliance and the intersectional relationships between the many governing bodies that are found in the healthcare industry can keep providers in business.
Mr. Delgado has always sought to create value in the healthcare industry and shift the focus away from its current antiquated business processes into the opportunities that the Information Age provides.
Do you want to get your practice set up with an effective compliance program that will save you time and money so you can focus on taking care of your patients? Contact us at www.ozarkcoding.com to get your practice onboard with our successful compliance tools.
Download our FAQ
Information and Pricing
Donate $1.00 to $10.00 a month to support us. You will get early access to episodes and access to Bonus episodes that come with CEUS.
Visit https://www.patreon.com/lifeasacoder to Donate and get CEUS. If you donate within Anchor please email Jennifer@ozarkcoding.com to register
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How are you Adjusting to the New Guidelines? Let’s talk about the updates and new codes Guideline Revisions
New Codes: 490
Let's Review some of my Favorite New Updates
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I am a very passionate coder and I absolutely love ICD10! Today I will break down some of my favorite tips and guidelines. Our Agenda:
Guideline Sections
Diabetes Guidelines
Coding for Neoplasms in the Index and the Tabular
7th Character Basics
Z code Tip break
“Breaking down” Fracture Guidelines
Do you want to learn more about ICD10 CM and ICD10 PCS? Join our summer ICD10 Class designed to enhance your ICD10 Skills and to prepare you for the CCS Exam! Visit www.ccscoder.com for more information Always familiarize yourself with the guidelines. READ READ READ!! 2021 ICD10 CM Guidelines 2021 ICD10 PCS Guidelines
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We have a very Special Guest Interview with Kyle Johnston, VP Client Services, Weller Healthcare IT Services that is here to help all Coding Professionals enhance their career and to help new coders create their footprint in the Industry. Our Agenda:
How can a new coder land a job?
What are the highest paying coding roles?
What is the benefit of working with a company that specifically hires coders versus being a coder directly employed by a physician practice or healthcare organization?
Should coders with no experience apply to positions that require multiple years of experience?
Is there any advantage to coders utilizing social media in their job search, like Facebook and LinkedIn?
What are some of your best tips for resumes, specifically for those either brand new out of school or new to coding due to a career switch?
How can a coder get in touch with recruiters?
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Get to know the very important HCPCS Level II Code book with us. Getting to know your code books is so important to be an effective coder and biller.
We will Discuss:
- Use of Level II HCPCS
- Modifiers
- C-codes
- G-codes
- J-codes
- S-codes
- NCCI Manual-Appendix
CMS Information
AAPC® Resources for HCPCS
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In this episode we will break down the CCS exam from my point of view. I tested and passed at the end of April and I had no Inpatient coding experience, All of my knowledge came from a prep course and my experience on the professional side of coding. We will review:
Coding Systems and Books Used
DRG Tips
Understanding Query for the Exam
Eliminating answers for PCS and the Structure
Make sure and join us this summer for our course on PCS and Inpatient Billing guidelines for the CCS exam. I have listed below some helpful tips and Resources
100 Tips for ICD-10-PCS Coding: Tips 1-10
The Coder & the Compliant Query
MS-DRG Tips
Join our FREE Webinar on 6/30/2021 and use code CCS21 and get 10% for our Inpatient Coding Workshop Available 7/15/2021 at the low cost of $129. All listeners get this discount on our course.
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Listen as we discuss the modern world of Telehealth Services and the concerns over compliance
Objective:
What is Telehealth?
What are the Pros and Cons of Telehealth?
How has it changed before and after the PHE?
Identify Privacy Risks
Proper Technology Requirements
EMR Requirements
Compliance and HIPAA
Compliant Coding for Risk Adjustment
What is the Future of Telehealth after PHE
Please see these helpful links mentioned in the podcast:
List of Telehealth Services | CMS
Telehealth - JF Part B - Noridian (noridianmedicare.com)
Telehealth.HHS.gov: How to get or provide remote health care
AMA quick guide helps doctors boot up their telemedicine practice | American Medical Association (ama-assn.org)
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Listen as we discuss the 7 key elements of Compliance Plan, There is alot of information out there on compliance plans. We will simplify what new practices need to know.
Objective:
7 Elements of a Compliance Plan
Why is it Required?
Making it Simple and Easy to Follow
Please see these helpful links mentioned in the podcast:
FREE Compliance Checklist
OIG Compliance Portal
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Listen as we discuss the key elements of Compliance and how to help your Physician understand its importance.
Objective:
What is Compliance?
What are the different Laws in place that Physicians need to know?
Providing easy to understand compliance.
Please see these helpful links mentioned in the podcast:
Compliance Overview-AAPC®
OIG Education Materials
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We want to talk today about Common Billing Mistakes encountered when billing for Gastrointestinal Procedures. We will discuss common areas such as:
Modifiers
Coding Bundles
Patient Education
Documentation and Medical Necessity
LCD Policy and Denial Management
If your Practice needs Coding assistance or Physician education please Book an Appointment with Jennifer
We have a new GI E/M 2021 Guidelines Course Starting in June and all Podcast Listeners can sign up by emailing admin@ozarkcodingllc.com and mentioning CODE: COLON and we will give you 10% off
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Which organization fits me best?
Do I want to work for a Facility or Physician Practice?
Do I want to invest in a degree program or an express entry into a coding course?
Will I get a job right away?
Here are some helpful Link so you can do research on your own:
https://www.ahima.org/certification-careers/certifications-overview/
https://www.medicaltechnologyschools.com/medical-coder/medical-coding-certification-guide
https://www.aapc.com/cpc-exam/where-do-medical-coders-work.aspx
I also encourage you to follow me on Linkedin and Network with me:
Jennifer McNamara CPC,CRC,CPMA,CPC-I,CGSC,COPC AAPC Approved Instructor
Thank you to our Production Team at Highland Productions
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Are you stressed out?
This Month is Stress Awareness Month and has been since 1992. Let’s review why we need to be aware of Stress and its effect on our bodies. I will talk about my struggles and how it has affected my personal and work life. We will discuss the term” Pandemic Fatigue” and how we need to adapt to the stress that the pandemic has had on us and may continue to affect us for quite some time.
Special thank you to our Music editing and Podcast Producer team at Wannabe Critic Production
Our resources for this podcast are:
https://nationaltoday.com/stress-awareness-month/
https://integracareclinics.com/april-is-stress-awareness-month-tips-to-help-you-cope/
https://www.stress.org/stress-awareness-month-april-2020
https://www.jhsph.edu/covid-19/articles/the-ills-of-pandemic-fatigue.html
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It was my first Healthcon from AAPC and I was invited as a speaker this year. It was a tough year in 2020 but in 2021 we were able to safely come together and experience the best that AAPC has to offer. Their education platform is top notch! We learned so many new things.
Top Events were:
E/M 2021 Guidelines
Telemedicine
Risk Adjustment
There were many who had to adapt to last minute changes due to speaker unavailability and we are so in awe of their sacrifice and being there to help things come together. Thank you AAPC for this opportunity and the privilege of representing you at HealthCon 2021! Can’t wait for 2022!
All listeners get a chance to receive a special Giveaway! Follow us and Share our podcast to be entered in our drawing for a special Webinar with 1 CEU of your choice from our Webinar Series! If you wish to receive special recognition as a
‘Life as a Coder” Patreon I encourage to donate $1 to our membership and receive all the perks as a member and special “Shout outs” from me
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Episode 6: Routine Footcare is a great reimbursement challenge for many Clinics and Providers for both the Clinical Staff and the Billing Staff. We will discuss what Routine foot care is as well as how to navigate the CMS Policy regarding these services. Objective: What is Routine Footcare? How do we get reimbursed when we can prove Medical Necessity Discuss the Diagnosis Sequencing Review the Layout of the LCD(Local Coverage Determination) Policy from CMS All Listeners will get 10% off our recent OrthoCare Virtual Summit in March for our March Madness deals! Visit our website www.ozarkcodingllc.com for additional educational webinars and courses. Our team is also available for Provider education for Podiatry if your clinic needs assistance in auditing or appealing your routine foot care claims.
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Welcome to the Life as a Coder Podcast Series brought to you by your friends at Ozark Coding alliance LLC. Discussing your life as a Medical Coder. Offering Coding Tips and Advice for Coding Students and Professionals. Join us every Monday!
Join me as I Interview my fellow podcasters and women who inspire me. I welcome Terry A, Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM and Sonal Patel, CPMA, CPC, CMC, ICD-10-CM as we talk about what New Clinics can do to start out successful and what Billing and process errors to avoid.
We will learn more about our Podcast Icons and what drives them to be successful in the Industry.
Listen to CodeCast with Terry A, Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM every Tuesday wherever you get your podcasts
Listen to Paint the Medical Picture with Sonal Patel, CPMA, CPC, CMC, ICD-10-CM every Wednesday wherever you get your podcasts
Objective:
Common Mistakes
Financial Impact on the Practice
Success Outcomes
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Welcome to the Life as a Coder Podcast Series brought to you by your friends at Ozark Coding alliance LLC. Discussing your life as a Medical Coder. Offering Coding Tips and Advice for Coding Students and Professionals.
Join us every Monday!
Join me as I interview Industry Icon Melissa Freeman RHIT, CDIP, CCS, CCS-P, CPC-I, CPC, COC, CRC.
She will help us understand the Industry landscape in our current environment and talk about the ways new coders need to adapt. We will discuss networking tips and ways to stand out and use LinkedIn effectively to market yourself and impress recruiters
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Welcome to the Life as a Coder Podcast Series brought to you by your friends at Ozark Coding alliance LLC. Discussing your life as a Medical Coder. Offering Coding Tips and Advice for Coding Students and Professionals. Join us every Monday
Career Development Strategy in 2021 is As part of my 2 part Interview Series I’ll be interviewing Industry Icon Kimberly Jolivette Williams CPC CPC-I CPMA CANPC CCC CEMC on how she has been successful and what changes she has seen in HIM.
Medical billing and coding is established as an in-demand profession. According to the Bureau of Labor Statistics, medical coding is among the 20 fastest-growing occupations. We will share our tips for:
-Navigating the Landscape -Offshore Competition -Credential in Specialty to stand out -Networking and Mentorships -Develop Short term and Long term goals
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Let's get back to Compliance and educate our providers on Signing the Documentation and why it is so important.
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Join us as we talk about the Data Elements of the New MDM guidelines for 2021. We will review the definitions of each Category and offer tips for success in Navigating this element of MDM. If you are a Visual learner we Invite you to visit our website www.ozarkcodingllc.com and Join or 2021 E/M Office Training course with excellent training and tools provided by the AMA® We also will be presenting Auditing tips for MDM in 2021 as part of our March Webinar Series. All you attend get 10% off the AMA® E/M Compendium. Register Here
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Lets talk about MDM!
• Updated MDM Tables
• New Definitions
• New Categories
New Course on the Upcoming changes by Ozark If you are Interested in Joining our November Course to learn the new changes, it comes with the training manual and Cases to review for Documentation from the AMA®
Register at www.ozarkcodingllc.com Get your 2021 CPT Manual with CPT® Assistant App for only $115 or the CPT® Manual for only $89 when you sign up Read the Official AMA Guidelines Here
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We will discuss some of the challenges for New Coders as they look into the Industry Job Market and What they can do to Improve
• Job Searching Skills
• Resume Tips
• Interview skills
• Using LinkedIn to Network
Grab our FREE Webinar at www.ozarkcodingllc.thinkific.com Go to Virtual Coding Summit: Mental Health Coding and use Code: Ozarkblitz at checkout
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We are launching our first Episode on the Importance of Mental Health. This is a timely topic as many are experiencing mental health issues related to being isolated more than ever before in the PHE environment. Learn
How Mental Health can be attacked How can we Stay Mentally Healthy?
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