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Category Archives: HIM Professionals

E&M Code Justification: Fraudulent vs. Compliance Correct Methodology


After my audio program last week, there is always a persistent question: “If I choose a code first before I document, coudn’t that be dangerous?”
Well, it’s a polite question that is really saying…”Isn’t this fraud?”
It’s not, and here’s why.
The three key components of an E/M code are:

Medical Decision Making, (MDM)

Two out of the three key […]

The Tyranny of Electronic Medical Records


The EMR movement has been touted to promote savings in healthcare dollars by eliminating redundant care with access to records, a way to compare performance of healthcare by standardization and uniformity, and with a seamless network to share data nationwide, despite ongoing concerns about privacy and who will have access  (authorized and unauthorized), and for […]

Easy for you to say… Language of Healthcare Misnomers


There are different “languages of healthcare.” Clinicians speak patient language but often don’t speak the healthcare language of regulation, quality, or finance. It pays to understand and effectively translate from one dialect to another. For instance, “medical necessity” may sound “clinical” but it’s really financial. For CMS, “medical necessity” doesn’t mean something that’s “medically necessary,” […]

SNEAK PEEK! New CMS Hospital Reimbursement HCAHPS Based Guidelines


Do you remember when HCFA, (a.k.a. CMS), released new documentation guidelines about ten years ago…. And then a few years later released “new” guidelines but promised to eventually release a totally revamped version… but you’ve been puzzled why that, frankly, never materialized? Well, it turns out the reason they’ve taken so long in “updating” those […]