Auditing Antics: Navigating Medical Coding and Auditing

Go to https://www.stephanieallardconsulting.com/online-shop/p/peripheral-vascular-lower-extremity-interventions-coding-and-compliance-essentials-1 and use code VASC15 at checkout for a discount on the upcoming Peripheral Vascular Lower Extremity Interventions: Coding and Compliance Essentials Event!There’s a phrase in compliance that should make every practice pause:“We’ve always done it this way.”In this episode of Auditing Antics, Stephanie and Michele unpack one of the most dangerous patterns in healthcare billing — the normalization of deviance. A coding practice that started small. A billing habit no one questioned. Claims that paid for years without issue. Until one denial. One probe. One data review changed everything.We walk through how long-standing habits become compliance blind spots, why teams genuinely believe they’re doing it right, and how the math of recoupments can unravel years of “routine” billing in a matter of months.Because payment history is not proof of compliance.And comfort is not a compliance strategy.If you’ve ever heard “but it’s always paid,” this episode is for you.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 Etsy shop here! https://sallardconsulting.etsy.com

Most audits don’t start with a complaint.They start with a pattern.Long before a human reviewer opens a chart, payer analytics are scanning utilization trends, benchmarking providers against peers, and flagging statistical outliers. Sudden shifts in coding levels. High-frequency services. Modifier usage patterns. Even documentation that looks too consistent.In this episode of Auditing Antics, Stephanie and Michele break down how data science drives audit selection and why many providers are flagged without ever realizing their billing trends stand out. We’ll talk about outlier patterns, utilization spikes, and the quiet metrics payers monitor behind the scenes.Because in today’s compliance environment, you’re not just being reviewed by auditors. You’re being watched by the numbers. If you’ve ever thought an audit felt random . This episode will change how you look at your data.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 Etsy shop here! https://sallardconsulting.etsy.com

Physicians document to reflect clinical care. Auditors review to validate compliance and billing accuracy. Same chart with a completely different lens.In this episode of Auditing Antics, we break down the mindset gap between providers and medical coding auditors. Why does something that feels clinically obvious sometimes fail an audit? Why does intent not always translate to compliant documentation? And what are auditors actually trained to look for that providers may not realize?We’ll explore how clinical thinking and compliance thinking intersect, and where they often disconnect, plus practical ways to bridge that gap. In compliance, it is not about questioning care but instead discussing what the record supports.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 Etsy shop here! https://sallardconsulting.etsy.com

Burnout impacts morale and accuracy.In this episode of Auditing Antics, Stephanie and Michele unpack how exhaustion, staffing strain, and constant regulatory shifts quietly increase compliance risk. When teams are stretched thin coding patterns may change. Small oversights turn into denials, downcoding, or audit findings.We’re connecting the dots between human fatigue and operational exposure because compliance mistakes can happen when energy is depleted and teams are struggling to focus.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-shopView our Etsy shop here!https://sallardconsulting.etsy.com

Find the Medical Coding Workroom Here!https://www.stephanieallardconsulting.com/medical-coding-workroom-1Find the Membership (that includes the Medical Coding Workroom) Here! Use code AUDITINGANTICS26 for a 26% discounthttps://www.stephanieallardconsulting.com/membershipGot coding questions you’ve been sitting on because the answer isn’t quite clear? This live Auditing Antics Q&A is where real-world healthcare coding and billing questions get real-time, audit-focused answers. We’re breaking down E/M leveling, documentation defensibility, payer downcoding, modifier misuse, and high-risk billing patterns before they turn into denials, takebacks, or audit findings.

What happens when a vaccine visit ends with education, but no immunization is administered? In this episode, we break down when immunization counseling may be reportable, what documentation is required, and the audit risks when vaccines are refused or deferred. Join us to learn about the new 2026 vaccine counseling codes.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-shop⁠View our Etsy shop here!⁠https://sallardconsulting.etsy.com⁠

Automatic E/M downcoding has become an increasingly common, and often unquestioned, practice in payer reviews and internal audits. In this episode of Auditing Antics, we break down what automatic downcoding is, why it happens, and when it crosses the line from compliance review into improper reimbursement reduction. We discuss how payers apply internal “rules” that override documented medical decision-making, the compliance risks this creates for providers, and how organizations can identify, challenge, and defend against inappropriate downcoding. If you’ve ever seen well-supported E/M services reduced without explanation, this episode will help you understand what’s happening and what to do next.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-shopView our Etsy shop here!https://sallardconsulting.etsy.com

Remote Patient Monitoring is often marketed as easy, hands-off revenue, but that mindset is exactly why RPM programs fail audits. In this episode of Auditing Antics, we explain why RPM is not passive income, what active provider involvement and documentation are required, and how treating RPM like an automated service can lead to denials, recoupments, and compliance risk.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-shopView our Etsy shop here!https://sallardconsulting.etsy.com

This episode explores a common misconception in healthcare documentation: using words or phrases from the E/M guidelines does not automatically support a higher level of complexity or risk. We discuss why documentation must reflect the actual medical decision-making, patient condition, and care provided, and offer practical guidance for creating notes that align with compliance and coding standards.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-shopView our Etsy shop here!https://sallardconsulting.etsy.com

In this episode, Skin Substitutes 2026: CMS Coverage vs Payment, we break down the growing confusion surrounding CMS’s decision to withdraw the Final Local Coverage Determinations for skin substitutes and what that decision does, and does not, mean for providers. With many assuming the LCD withdrawal delays or stops upcoming reimbursement changes, we separate fact from fiction and explain why that assumption creates real compliance and financial risk.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-shopView our Etsy shop here!https://sallardconsulting.etsy.com

‘Tis the season for reflection—and preparation! In this special holiday episode of Auditing Antics, “Audit Under the Mistletoe: 2025 Wrap-Up & 2026 Prep,” we cozy up with a review of the year’s key coding and compliance insights and set the stage for a successful 2026. Whether you’re a coder, auditor, or compliance professional, this episode will help you end the year informed, inspired, and ready to tackle 2026 with confidence—no mistletoe mishaps required!#AuditingAntics #MedicalCoding #HealthcareCompliance #AuditPlanning #TPE #RevenueCycle #CodingUpdates #2026Audits #HolidayWrapUp #ComplianceTips #HealthcareAudits #CodingLife #AuditReady #MedicareCompliance #HIPAA #RiskManagement #CodingCompliance #AuditSeason #HealthcareRevenue #RevenueIntegrity #MedicalAudit #ComplianceMatters #CodingExcellence #HealthcareUpdates #AuditInsights #MedicalBilling #ComplianceStrategy #YearEndReview #NextYearPrep #AuditChecklist #HolidayCompliance #PodcastForCoders #HealthcarePodcast #MedicalCodingPodcast #CompliancePodcast #RevenueCyclePodcast #AuditPodcast #MedicareAudit #HealthcareLeadership #MedicalCompliance #CodingCommunity #HealthcareProfessionals #AuditTalk

Join us on Auditing Antics as we break down the world of Evaluation & Management (E/M) services, one data element at a time. In this episode, we’ll analyze key data elements, uncover common documentation pitfalls, and explore how accurate coding drives compliance and revenue integrity. Perfect for auditors, coders, and compliance pros looking to sharpen their skills with real-world insights and practical tips.#AuditingAntics #EMData #DataAnalyzed #MedicalCoding #HealthcareCompliance #RevenueIntegrity #AuditLife #CodingAudit #EMServices #EvaluationAndManagement #HealthcareAuditing #DocumentationMatters #CodingCompliance #RevenueCycle #AuditInsights #MedicalAuditing #DataDriven #AuditEducation #HealthcareData #CodingTips #ComplianceTips #AuditTips #EandMServices #AuditDeepDive #CodingLife #AuditAnalytics #HealthcareCoding #MedicalRevenue #ComplianceAudit #ChartReview #EMCoding #AuditEducation #HealthcareAudit #RevenueCycleManagement #DataDissected #CodingExcellence #AuditCommunity #MedicalDocumentation #AuditReview #HealthcareInsights #RevenueIntegrityMattersReach 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 special Thanksgiving episode, Stephanie and Michele take a heartfelt pause to reflect on the people and moments that make the world of medical coding and compliance something to truly be thankful for. From supportive teams and passionate educators to the coders and auditors who keep healthcare running smoothly, this conversation is all about gratitude, connection, and community.#AuditingAntics #ThankfulAndCompliant #ThanksgivingEpisode #MedicalCoding #HealthcareCompliance #CodingCommunity #ComplianceProfessionals #HealthcareAuditing #MedicalAuditing #RevenueIntegrity #DocumentationMatters #ComplianceTalk #CodingEducation #HealthcarePodcast #CoderLife #BillingAndCoding #ComplianceMatters #ComplianceTips #HealthcareLeaders #ComplianceCulture #HealthcareRevenueCycle #GratefulCoders #ComplianceCommunity #CodingProfessionals #HealthcareIndustry #ProfessionalGrowth #ComplianceEducation #HealthcareHeroes #MedicalBilling #ContinuousLearning #GratitudeInHealthcare #ComplianceAwareness #ComplianceLifeReach 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, Stephanie and Michele tackle your most pressing medical coding and compliance questions in real time! From tricky documentation scenarios to evolving regulatory updates, they’re diving into what’s keeping coders and compliance pros up at night. Tune in for practical insights, real-world examples, and a few laughs along the way.#AuditingAntics #MedicalCoding #ComplianceTalk #HealthcareCompliance #CodingEducation #AskUsAnything #LiveQandA #HealthcareAuditing #MedicalAuditing #CodingCommunity #ComplianceTips #HealthcareRegulations #DocumentationMatters #CodingLife #ComplianceProfessionals #HealthcarePodcast #CoderLife #BillingAndCoding #RevenueIntegrity #ComplianceEducation #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

Join us with special guest Yoelvis Reyes, CPC, CRC, for an inspiring discussion exploring the evolving world of medical coding where English and Spanish-speaking professionals come together to share insights, opportunities, and challenges shaping the future of our field. We’ll dive into AI’s impact on coding, the growing demand for bilingual talent, key traits employers seek, and how education in Spanish can open new doors in healthcare. Whether you're a seasoned coder or just starting out, this conversation will help you see how to stand out, grow, and thrive in a changing industry.Check out Codingforhealth and Yoelvis here!https://codingforhealth.com/home#MedicalCoding #HealthcareCompliance #BilingualCoding #CodingCareers #HealthcareProfessionals #AIinHealthcare #MedicalBilling #HealthInformationManagement #FutureOfCoding #BilingualProfessionals #RemoteCoding #CodingEducation #HealthTech #FutureOfHealthcare

In this episode of Auditing Antics, Stephanie sits down with Ron Chapman II, one of the nation’s top federal healthcare defense attorneys, to unpack the growing wave of UPIC audits and investigations in wound care—especially those involving skin grafts and cellular/tissue-based products. A former prosecutor and U.S. Marine Corps Judge Advocate, Ron brings a powerful dual perspective on how enforcement actions take shape and what providers can do to stay protected. Together Stephanie and Ron will explore recent audits they are collaborating on and identify the fine line between medical necessity and overutilization, how documentation can make or break a case, and what recent UPIC trends reveal about the government’s next moves in wound care.Federal Criminal Defense Attorney Ronald W. Chapman IIhttps://ronaldwchapman.com/Safe Harbor Grouphttps://safehg.com/#AuditingAnticsPodcast #Podcast #WoundCareAudits #UPIC #UPICAudits #HealthcareCompliance #MedicalAuditing #AuditReadiness #HealthcareLaw #HealthLaw #ComplianceMatters #MedicalCoding #MedicalBilling #RevenueIntegrity #SkinGrafts #CellularTherapies #CTPs #WoundManagement #HealthcareInvestigations #OIG #CMSAudits #ProgramIntegrity #FraudWasteAbuse #ComplianceLeadership #HealthcareRisk #ProviderEducation #LegalInsights #HealthcareDefense #AuditTrends #WoundCareCompliance #AuditStrategy

Gather around the (virtual) campfire as we share real-life “horror stories” from coding audits gone wrong! From missing modifiers to documentation disasters. Learn how to turn these coding nightmares into compliance success stories.#MedicalCoding #AuditHorrorStories #HalloweenSpecial #CodingCompliance #MedCoderLife #MedicalAuditing #RevenueIntegrity #HealthcareCompliance #CodingEducation #HealthcarePodcast #ComplianceCommunity #RevenueCycle #MedicalBilling #CodingAudit #CPTCoding #ICD10 #ComplianceTips #HIMProfessionals #HealthcareHumor #SpookySeason #CodingLife #AuditorLife #HealthcareLeadership #ComplianceAwareness #DocumentationMatters #Podcast #AuditingAntics #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/services View 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, we unpack how a federal government shutdown could affect Medicare telehealth services—from delays in policy updates and payment processing to disruptions in provider support and patient access. We’ll explore what providers and beneficiaries should know, how to stay compliant during uncertainty, and what safeguards may (or may not) be in place to keep telehealth running. Tune in for practical insights on navigating healthcare operations when Washington goes dark.#Medicare #Telehealth #GovernmentShutdown #HealthcarePolicy #MedicalBilling #Compliance #HealthIT #MedicareAdvantage #HealthcareReform #HealthLaw #CodingCompliance #HealthcareLeadership #RevenueCycle #HealthEquity #MedicalCoding #MedicalCoder #MedicalAuditing #AuditingAntics #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

In this eye-opening episode of Auditing Antics podcast, we turn the spotlight on you the auditor and coder. What risks come with reviewing others’ work, and how can you avoid becoming part of the compliance problem yourself? We’ll explore real-world scenarios where professional judgment, documentation, and ethical lines blur and share practical steps to protect your license, credibility, and career.#AuditingAntics #MedicalAuditing #ComplianceRisk #HealthcareCompliance #MedicalCoding #AuditorLife #RiskManagement #RevenueIntegrity #HealthcareEthics #AuditEducation #ComplianceAwareness #HealthcareLeadership #HealthcareRegulations #AuditCulture #DocumentationMatters #ProfessionalIntegrity #ComplianceJourney #MedicalAuditor #HealthcareFraudPrevention #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

Join us as we discuss the essentials of ICD-10-CM diagnosis coding, common documentation pitfalls, and the compliance red flags every auditor, coder, and compliance professional should recognize. Whether you’re coding for accuracy or auditing for integrity, this episode delivers real-world insight with compliance clarity.#AuditingAntics #ICD10CM #MedicalCoding #CodingCompliance #HealthcareAuditing #CompliancePodcast #HealthcareCompliance #ClinicalDocumentation #DiagnosisCoding #MedicalAuditors #AHIMA #AAPC #RevenueIntegrity #HealthcareEducation #ComplianceMatters #MedicalBilling #AuditFindings #HealthcareProfessionals #CodingAccuracy #DocumentationMatters #CodingLife #ComplianceCorner #CodeTalk #HealthcarePodcasts #AuditorInsights #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