Auditing Antics: Navigating Medical Coding and Auditing

Ep. 121 - Medicare Advantage: The Payer Tactics Practices Need to Know (ft. Stephanie Allard)🍎 Apple Podcasts: https://podcasts.apple.com/us/podcast/ep-121-medicare-advantage-the-payer-tactics-practices/id1746629912?i=1000791075227🟢 Spotify: https://open.spotify.com/episode/2cpXMNNbaMWM7hRaBcqUq3Those of us who work in healthcare understand how complex Medicare choices can be and how significantly those decisions can affect access to physicians, specialists, hospitals, medications, and other necessary services.In this episode, we discuss why healthcare professionals should take the initiative to share what we know with our patients, families, and communities. We break down the differences between Original Medicare and Medicare Advantage, highlight important questions people should ask before enrolling, and explore how better education can help individuals make informed choices based on their healthcare needs instead of relying solely on premiums, advertisements, or added benefits.

Surgery may be mentioned throughout multiple progress notes, but that does not mean every encounter supports a decision regarding surgery. In this episode, Stephanie and Michele explain the difference between discussing surgery as a future possibility and documenting an actual surgical decision. They review what coders should look for, including the provider’s recommendation, treatment alternatives, patient-specific risks, the patient’s choice, and the resulting plan. They also discuss decisions to proceed, postpone, or decline surgery.

Join us on Patreon! https://www.patreon.com/cw/AuditingAnticsPodcastA diagnosis appearing in the medical record does not automatically count toward the E/M level. In this episode, Stephanie and Michele break down one of the most misunderstood elements of medical decision-making: the number and complexity of problems addressed. They discuss the difference between problems that are listed, mentioned, monitored, evaluated, and actively managed—and explain how terms such as stable, worsening, exacerbated, acute, and uncertain affect code selection. Using practical examples, they show why the same diagnosis can support different E/M levels and what documentation is needed to demonstrate the provider’s work.

For the first time on the Auditing Antics Podcast, Michele Strickland and Stephanie Allard are recording live and together in person!In this episode, Michele and Stephanie break down the biggest highlights from the CY 2027 Medicare Physician Fee Schedule Proposed Rule and talk through what these proposals could actually mean for healthcare organizations and physician practices. From the proposed Modifier 25 payment reduction and changes to G2211, to new ACO incentives, remote patient monitoring requirements, telehealth updates, MIPS changes, and continued pressure on physician reimbursement, there is a lot for practices to pay attention to.As always, they go beyond simply reading the rule and discuss the real world impact on coding, compliance, reimbursement, and practice workflows.And this episode is a little more fun because after all of their remote podcast recordings, Michele and Stephanie are finally sitting across from each other recording Auditing Antics together in person!https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2027-ipps-final-rule-home-page

AI is rapidly becoming part of healthcare operations, but implementing the technology is only the beginning. How do organizations know their AI tools are secure, accurate, compliant, and continuing to perform as intended?In this episode of Auditing Antics, we’re joined by Bennett Borden, Founder and CEO of Clarion AI Partners, to discuss the use, implementation, governance, and ongoing monitoring of AI in healthcare. Bennett brings a unique background spanning service with the CIA and U.S. Intelligence, law, data science, and AI governance.We’ll discuss what healthcare organizations should consider before implementing AI, why human oversight and ongoing monitoring matter, and how to make sure AI innovation doesn’t create new compliance and security risks.🔗 Click here to learn more about Bennett and Clarion AI Partnershttps://clarionai.com/