The Pulse

In the latest episode of The Pulse, we dive into the world of healthcare finance, focusing on the complexities of coding, billing, and revenue cycle management. Featuring Stephanie DeBarge, a seasoned expert in hematology and oncology practice management, this episode provides insights into the challenges and solutions in managing new and emerging drugs, and best practices for ensuring compliance and optimizing revenue. You'll learn: The multi-step FDA drug approval process and its impact on billing Strategies for managing clinical trials and billing for new drugs The importance of accurate National Drug Code (NDC) numbers and compliance How to implement and document drug waste using the JZ modifier Essential lab work and documentation practices for administering drugs Valuable resources for coders to find up-to-date drug information

Join us as we explore the benefits of outsourcing coding support to manage staffing shortages, overcome backlogs, improve efficiency, and save money. In this episode of The Pulse, Lori Cox is joined by Melinda Craig, RHIA, CCS, AAPC Director of Coding Services, to discuss how outsourcing coding can provide a much-needed boost for healthcare organizations. They'll explore why 90% of hospital leaders are considering third-party vendors for coding support and how outsourcing can free up valuable resources for essential tasks. From quality assurance to data security, they address common concerns and provide practical tips for vetting potential outsourcing partners. Discover the power of leveraging third-party coding support to: • Address staffing shortages • Overcome backlogs • Enhance operational efficiency • Save money

In this episode of The Pulse, Lori Cox is joined by Lamon Willis, a seasoned expert with 20+ years of experience in healthcare auditing, billing, coding, and consulting, now serving as Solutions Director at AAPC Audit Services. Together, they dive into the challenges and opportunities facing healthcare institutions today, highlighting key areas to identify root causes for gaps in reimbursement. From navigating the complexities of hospital margins to leveraging price transparency regulations, this episode offers insights to empower you to make decisions that lead to financial success.  Key Discussion Points:  Hospital margins and financial challenges  Price transparency and competitive dynamics  Contract negotiation and management  AI and technology in revenue optimization  Identifying revenue drain areas  Pre and post charge audit reviews

As audits are increasing across the country, you need to know how to defend your reimbursements from payers and CMS. In this podcast of The Pulse, Lori Cox sits down with Michael Miscoe, an accomplished attorney, coding and software development professional, and former President of AAPC's National Advisory Board. They discuss post-payment audits and clawbacks, dive into statistical samples, and share insights on defending coding accuracy, when to seek legal advice, and how to leverage third-party support if audited or fined. Listen now to: Explore the best approach for compliance plans, especially for smaller physician practices. Uncover the complexities of auditing medical claims, including identifying and correcting errors in E/M services. Discover distinctions between federal healthcare program claims and non-federal claims, unraveling the obligations triggered by potential incorrect payments.

In this episode of The Pulse, Lori Cox sits down with special guest Tracy Bird to delve into the world of benchmarking. They discuss how benchmarking can improve various aspects of healthcare practice management, including cost reduction, operational efficiency, and patient outcomes. You'll learn: Key benefits of benchmarking for healthcare practices How to use benchmarking data to streamline your revenue cycle and reduce costs Role of AI in benchmarking and its impact on the future of healthcare Connection between benchmarking and social determinants of health Importance of a collaborative team effort in making data-driven decisions for better patient care

In this episode of The Pulse, Lori Cox sits down with AAPC's Chief Product Officer, Raemarie Jimenez, to discuss one of the most significant advancements in the healthcare field: Artificial Intelligence (AI). They examine how AI will impact the industry, what those changes mean for both professionals and organizations, and more. Listen now to learn: The potential revolution of medical billing and coding Fact vs. fiction regarding concerns surrounding AI Evolving roles and opportunities for coders and billers AAPC's commitment to keeping you informed and compliant

On this episode of The Pulse, host Lori Cox teams up with guest Dawn Carter to discuss the crucial role of social determinants of health (SDOH) in shaping health outcomes. Did you know that SDOH account for a staggering 80 to 90% of health outcomes? Lori and Dawn examine the five major domains of SDOH. They also highlight the importance of appropriate screening tools, such as P.R.E.P.A.R.E., for improving documentation and effective data collection. With nearly 60% of individuals reporting that they have never discussed SDOH with their healthcare providers, Lori and Dawn emphasize the need to raise awareness and facilitate conversations around SDOH to ultimately drive better healthcare outcomes.

What does risk adjustment look like from a provider's perspective? In this episode of The Pulse, Lori Cox and Rhonda Buckholtz dive into the risk adjustment program and why it appears to be broken. They explore the challenges providers face when it comes to risk adjustment and explore potential solutions to these issues, including renegotiating contracts, additional education, and population-based care.

In this episode of The Pulse: Examining the Business of Healthcare, Lori Cox sits down with Karen Bowman, FACMPE, CPC, CPMA, to discuss staffing solutions, specifically how she attracts and retains top-tier talent. With more than 40 years of experience, Karen shares insights on: Networking with AAPC local chapters Being a leader vs. being a boss The value of an open-door policy Offering unique benefits to employees Managing work/life balance Overstaffing vs. understaffing Training new employees

From Patient to Payment: A Deep Dive Into Revenue Cycle Management by The Pulse by AAPC

In this episode of The Pulse: Examining the Business of Healthcare, Charla Prillaman comes out of retirement to join Lori Cox for a conversation on how auditors can — and should — approach providers about errors in their documentation.

Exploring the Audit Process by The Pulse by AAPC

In this episode of The Pulse, Lori Cox and Pam Brooks sit down to discuss split/shared services. With the patient experience, compliance, and reimbursement in mind, these industry experts answer questions.

In this episode of The Pulse, Lori Cox and Lee Williams sit down to discuss the 2023 E/M Guideline changes. With compliance, revenue, and the patient experience in mind, these experts answer frequently asked questions related to the upcoming changes, such as: Does this mean we will no longer use the 95 and 97 guidelines? Will consultations still require history, exam, and MDM? Will we still have Place of Service 21 and 22? What would the ideal time statement be? What is the best way to educate providers on these changes?

Risk Adjustment (RA) is a complicated and fast-growing area in the business of healthcare. In this episode, Lori Cox sits down with Dr. Khush Singh, a well-known risk care management consultant, to talk about lawsuits related to RA, increased activity from OIG and the Department of Justice, and to answer questions like: Due to these risk adjustment lawsuits, what changes do you see coming in the next few years? What role do coders play in the quality of care? Do you think we will be able to pull diagnosis from other types of documentation? What advice do you have for providers participating in managed Medicare plans?