Auditing Antics: Navigating Medical Coding and Auditing

Link to On-Demand Telehealth Event:https://www.stephanieallardconsulting.com/online-shop/p/the-future-is-now-2025-the-next-era-of-telehealth-compliance-and-codingStarting October 1, 2025, both Aetna and Cigna are set to implement automatic downcoding policies for evaluation and management (E/M) services, without even reviewing clinical documentation. In this episode of Auditing Antics, we break down what this means for providers, the compliance and reimbursement risks ahead, and how you can prepare to push back. Join us as we discuss the implications of payers playing doctor and the ripple effects for coding integrity, audits, and ultimately patient care.#EMServices #EMAuditing #MedicalCoding #CodingUpdates #CodingChanges #HealthcareCoding #HealthcareAuditing #RevenueCycle #ComplianceMatters #CodingCompliance #PayerPolicy #InsuranceChanges #DowncodingDebate #ProviderAdvocacy #ProtectProviders #FairReimbursement #CodingIntegrity #PayerWatch #HealthcareEquity #HealthcareNews #HealthcarePolicy #HealthSystem #MedicalNews #PracticeManagement #ProviderSupport #DocumentationMatters #CodingCommunity #AuditorLifeReach Out For Compliance Help Now!https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our online shop here! https://www.stephanieallardconsulting.com/online-shopView our Etsy shop here!https://sallardconsulting.etsy.com

In this episode of Auditing Antics, we dive into the latest CMS updates for E/M services, effective Sept 2025. We will break down the changes you need to know to stay compliant and optimize coding accuracy. Perfect for auditors, coders, and compliance professionals looking for a clear, practical guide.#MedicalCoding #EMUpdates #CMS2025 #HealthcareCompliance #AuditingAntics #Telehealth #CriticalCareBilling #HealthcareAuditing #EMservices #MedicalAudit #RevenueCycle #CPTCoding #Podcast #StephanieAllardConsultingReach Out For Compliance Help Now!https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our online shop here! https://www.stephanieallardconsulting.com/online-shopView our Etsy shop here!https://sallardconsulting.etsy.com

The global surgical package can be tricky. Trying to figure out what is included, what’s not, and how to code it right. In this episode, we clear up the confusion with practical tips to help stay compliant!#MedicalCoding #BillingCompliance #GlobalSurgicalPackage #HealthcareBilling #CodingTips #RevenueCycle #MedicalBilling #Medical #Healthcare #Compliance #HealthccareCompliance #MedicalAuditing #RemoteWork #Podcast #StephanieAllardConsulting #AuditingAnticsPodcastReach Out For Compliance Help Now!https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our online shop here! https://www.stephanieallardconsulting.com/online-shopView our Etsy shop here!https://sallardconsulting.etsy.com

It’s time for your questions to take the spotlight! In this Q&A session, we’re diving into the everyday challenges medical coders, billers, and compliance professionals face. From gray areas in documentation to tricky billing scenarios and compliance red flags, we’ll tackle it all with practical strategies and clear guidance. Tune in for straightforward answers that can help you avoid denials, reduce audit risk, and strengthen your coding confidence.🚀 Don’t miss this opportunity to stay ahead in telehealth!1.5 CEU's for AAPC, AHIMA, QPro, PMI, BMSC CEU's📌Register now:https://www.eventbrite.com/e/the-future-is-now-2025-the-next-era-of-telehealth-compliance-and-coding-tickets-1622301299859?utm-campaign=social&utm-content=attendeeshare&utm-medium=discovery&utm-term=listing&utm-source=cp&aff=ebdsshcopyurl#MedicalCoding #ComplianceTalk #HealthcareAuditing #RevenueCycle #CodingTips #ComplianceMatters #HealthcarePodcast #AskTheAuditor #MedicalBilling #HealthcareCompliance #StephanieAllardConsulting #AuditingAnticsPodcast

In this episode, we shine a light on one of the most common—and costly—mistakes in medical coding: making assumptions. Whether it’s inferring a diagnosis, assuming laterality, or “filling in the blanks” when documentation is unclear, assumption-based coding opens the door to compliance risks, denials, and even audit findings.#MedicalCoding #RevenueCycle #Compliance #MedicalBilling #HealthcareCompliance #CodingEducation #AuditReady #DocumentationMatters #RevenueIntegrity #HealthcareFinance #CoderLife #DenialManagement #HealthLaw #CodingTips #ICD10 #CPTCoding #StephanieAllardConsulting #AuditingAnticsPodcastReach Out For Compliance Help Now!https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our online shop here! https://www.stephanieallardconsulting.com/online-shop

Timely provider signatures aren’t just a formality—they’re the green light for revenue flow. Learn how late or missing sign-offs can cost your organization, and strategies to keep documentation on schedule.#MedicalCoding #HealthcareCompliance #MedicalAuditing #CMS #Documentation #AuditReady #MedicareCompliance #CodingEducation #HealthcarePodcast #AuditingAntics #ChartAudits #MedicalNecessity #ComplianceMatters #Healthcare #Medical #RevenueIntegrity #ClinicalDocumentation #MedicalCoderReach Out For Compliance Help Now!https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our online shop here! https://www.stephanieallardconsulting.com/online-shopEtsy shop for coding/compliance merch! https://sallardconsulting.etsy.com

In this episode of Auditing Antics, we dive into the growing concerns surrounding the use of templates in documentation and how CMS views their impact on medical necessity, specificity, and over-documentation. Understanding the risks of cloned or boilerplate notes is critical to protecting your organization from denials or recoupments.🩺✨ We are excited to announce our new merchandise collection, designed specifically for those of us in the medical coding, billing, auditing, education, and compliance industry!Our collection features mugs, apparel, stickers, and more — each thoughtfully created to reflect your dedication and to bring some fun to your work every day. Whether you’re looking to add a touch of personality to your workspace or share your passion for accuracy and compliance, these items are a perfect fit.💫 Explore the collection here!https://sallardconsulting.etsy.com#MedicalCoding #HealthcareCompliance #MedicalAuditing #CMSCompliance #Documentation #TemplateRisks #ClonedNotes #CopyPaste #AuditReady #MedicareCompliance #CodingEducation #HealthcarePodcast #AuditingAntics #ChartAudits #MedicalNecessity #ComplianceMatters #Healthcare #Medical #RevenueIntegrity #ClinicalDocumentation #MedicalCoderReach Out For Compliance Help Now!https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our online shop here! https://www.stephanieallardconsulting.com/online-shop

When you're an in-network provider, charging for administrative tasks could violate your payer agreement. We dig into real-world examples and offer practical tips to navigate this growing gray area without triggering compliance issues.#MedicalBilling #HealthcareCompliance #RevenueCycle #MedicalCoding #AuditReady #AdminFees #InNetworkProviders #PayerContracts #HealthcareLaw #AuditingAntics #BillingCompliance #PracticeManagement #MedicalAuditing #HealthLaw #ComplianceMatters #StephanieAllardConsultingReach Out For Compliance Help Now!https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our online shop here! https://www.stephanieallardconsulting.com/online-shop

When your medical practice is facing an external investigation, preparation and understanding are your best defense. In this episode with Sean Weiss and Eric Rubenstein, we will break down how to navigate the complex process of medical coding and billing investigations whether prompted by the government, a commercial payer or a whistleblower complaint. Tune in for practical tips and expert insight that every compliance officer, coder, auditor and healthcare leader should know.Reach Out For Compliance Help Now!https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership View our online shop here! https://www.stephanieallardconsulting.com/online-shop

During this episode we will be joined by special guest Scott Kraft and dive into the real-world challenges of working with providers who are overwhelmed, frustrated, and sometimes resistant when it comes to coding and compliance. We will explore the reasons behind pushback, the impact of burnout, and how to bridge the gap between clinical care and regulatory requirements.Reach Out For Compliance Help Now! ⁠⁠https://www.stephanieallardconsulting.com/contact⁠⁠ Sign up for our updates and the latest compliance news here! ⁠⁠ https://www.stephanieallardconsulting.com/⁠⁠Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!⁠⁠ https://www.stephanieallardconsulting.com/auditing-antics-podcast⁠⁠View our compliance consulting, auditing, and education services here!  ⁠⁠https://www.stephanieallardconsulting.com/services⁠⁠View our Coding Compliance Connection membership here!  ⁠⁠https://www.stephanieallardconsulting.com/membership⁠⁠ View our online shop here! https://www.stephanieallardconsulting.com/online-shop⁠

Medicare spending on skin substitutes has skyrocketed jumping from $256 million to over $10 billion in just five years. In this episode, we explore how CMS is addressing abuse, fraud, and excessive pricing with bold policy shifts that could cut spending by 90%. Let’s talk compliance and cost control.#MedicalCoder #MedicalCoding #MedicareSpending #CMS #SkinSubstitutes #HealthcareCompliance #CMSUpdates #WoundCareBilling #HealthPolicy #MedicalCoding #AuditAndCompliance #IncidentToBilling #Health #Medical #MedicalCodingandBilling #AAPC #AHIMA #AuditingAntics #StephanieAllardConsultingLLCReach Out For Compliance Help Now! ⁠https://www.stephanieallardconsulting.com/contact⁠ Sign up for our updates and the latest compliance news here! ⁠ https://www.stephanieallardconsulting.com/⁠Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!⁠ https://www.stephanieallardconsulting.com/auditing-antics-podcast⁠View our compliance consulting, auditing, and education services here!  ⁠https://www.stephanieallardconsulting.com/services⁠View our Coding Compliance Connection membership here!  ⁠https://www.stephanieallardconsulting.com/membership⁠ View our online shop here!  ⁠https://www.stephanieallardconsulting.com/online-shop⁠

In this episode, we dive into the critical role internal audit plans play in staying ahead of payer denial patterns and revenue integrity. With denials on the rise and payers shifting requirements without warning, medical coding and compliance teams must be proactive, not reactive.Go to https://www.stephanieallardconsulting.com/ to download the audit plan now!Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contact Sign up for our updates and the latest compliance news here!  https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership View our online shop here!  https://www.stephanieallardconsulting.com/online-shop

I’m excited to have Dr. Khush Singh join me in the studio for an important and timely discussion related to value-based care and the growing pressure around accurate coding and documentation especially when it comes to HCCs. In this episode, Dr. Singh and I will unpack what RADV audits really focus on, why precise HCC documentation is more important than ever, and how even small gaps can lead to major issues. Not only can these audits lead to hefty repayments, but they can also uncover patterns that trigger deeper investigations under the False Claims Act (FCA).Find Dr. Khush Singh here on LinkedIn! https://www.linkedin.com/in/drksingh/Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here!  https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership ​View our online shop here!  https://www.stephanieallardconsulting.com/online-shop

With government audits on the rise, accurate risk adjustment coding is more critical than ever. In this episode, we break down what’s at stake for physician practices, common coding pitfalls, and how to stay compliant and audit-ready.Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership  View our online shop here!  https://www.stephanieallardconsulting.com/online-shop

During this episode we will discuss why professionals that are new in the industry or in a new position advancing their career should seek out specific support as a part of their career development. The medical coding and billing industry is saturated with people who are looking anywhere to gain experience without fully understanding what practices and organizations need and what will help them achieve their longer term goals.Reach Out For Compliance Help Now!⁠ https://www.stephanieallardconsulting.com/contact⁠Sign up for our updates and the latest compliance news here! ⁠https://www.stephanieallardconsulting.com/⁠Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!⁠ https://www.stephanieallardconsulting.com/auditing-antics-podcast⁠View our compliance consulting, auditing, and education services here! ⁠ https://www.stephanieallardconsulting.com/services⁠View our Coding Compliance Connection membership here! ⁠ https://www.stephanieallardconsulting.com/membership⁠  View our online shop here!  ⁠https://www.stephanieallardconsulting.com/online-shop⁠

During this episode Sean Weiss "The Compliance Guy" and I will discuss how AI tools are at times considered organizational resources rather than reimbursable services. That means hospitals and practices often absorb the costs without direct payment from payers, as most AI-assisted functions don't fall into existing CPT or HCPCS code categories. We will address what this means for health systems investing in AI and how to evaluate ROI beyond reimbursement. Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here!  https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership  View our online shop here!  https://www.stephanieallardconsulting.com/online-shop

Join us for a live Q&A session addressing current challenges in medical coding, billing, and compliance. Industry experts Stephanie Allard and Michele Strickland will provide guidance on documentation, coding, and best practices to support accurate and compliant claims processing.Reach Out For Compliance Help Now! https://www.stephanieallardconsulting.com/contactSign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/ Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/services View our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership  View our online shop here!  https://www.stephanieallardconsulting.com/online-shop

Medical coding and billing professionals are vital to the healthcare system, but their mental health is often overlooked. Between intense accuracy demands, ever-changing regulations, high quotas, and the isolation of remote work, many are quietly facing burnout and stress. Sign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership  View our online shop here! https://www.stephanieallardconsulting.com/online-shop

During this episode we will discuss what it takes to turn written policies into impactful action. Join us as we review strategies to make policies work not just on paper in a binder on a shelf, but in actionable practice.Sign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry! https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here!  https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here!  https://www.stephanieallardconsulting.com/membership  View our online shop here!  https://www.stephanieallardconsulting.com/online-shop

In this episode we will explore the different departments, leaders and employees within a small and large organizations that need to come together for the creation of policies. Join us as we identify how key departments and leaders can collaborate effectively to create clear, actionable, and sustainable policies and procedures. Sign up for our updates and the latest compliance news here! https://www.stephanieallardconsulting.com/Find our AUDITING ANTICS PODCAST for regular updates and discussions related to compliance in the medical coding and billing industry!https://www.stephanieallardconsulting.com/auditing-antics-podcastView our compliance consulting, auditing, and education services here! https://www.stephanieallardconsulting.com/servicesView our Coding Compliance Connection membership here! https://www.stephanieallardconsulting.com/membership  View our online shop here! https://www.stephanieallardconsulting.com/online-shop