 The Fall Professional Medical Coding Course has been scheduled at Kent Hospital and will begin on Saturday, September 7th with a Preview Workshop to prepare students for success! The CPC exam will be proctored on Saturday December 7th, 2012. Click here to view the syllabus.The course will be held in classroom 4B of the Trowbridge Building at Kent Hospital on Tollgate Road in Warwick, RI. Classes begin at 8am and end at 1pm. Tuition is $2,000 and includes the Course, AAPC Textbook, AAPC Membership fee and CPC Exam (2 opportunities to take the exam). A deposit of $500 is required for registration and the balance is due on or before the first day of class. CLICK HERE TO REGISTERAdvance your career and attain CPC Certification. The course will cover subjects including CPT, ICD-9, HCPCS, Compliance, the Business of Medicine, Anatomy and Medical Terminology. Click on the " Education" tab for more information and to register.
 TRENTON, NJ—A physician who was the owner and founder of Visiting Physicians of South Jersey—a Hammonton, New Jersey provider of home-based physician services for seniors—pleaded guilty today for charging lengthy visits to elderly patients that they did not receive, U.S. Attorney Paul J. Fishman announced. Lori Reaves, 52, of Waterford Works, New Jersey, entered her guilty plea to an information charging her with one count of health care fraud before U.S. District Judge Freda L. Wolfson in Trenton federal court. During her guilty plea, Reaves admitted lying in Medicare billings about the amount of face-to-face time she spent with patients, which led to her receiving at least $511,068 in criminal profits. Reaves was the highest-billing home care provider among the more than 24,000 doctors in New Jersey from January 1, 2008 through October 14, 2011, according to court documents. “Today, Lori Reaves, a South Jersey physician, admitted intentionally overbilling Medicare and pocketing more than half a million dollars she didn’t earn,” U.S. Attorney Fishman said. “The Medicare system depends on doctors and other medical professionals truthfully billing for services they actually provide. Here, Dr. Reaves chose to lie about the major service she was providing to her homebound, elderly patients: her time.” ----------------------------------------------- Reaves routinely billed Medicare using codes that would have required her—under Medicare regulations and depending on the corresponding service—to spend between 60 and 150 minutes with a patient. Many of the claims Reaves submitted would have required her to spend a minimum of two-and-a-half hours of face-to-face time with her elderly clients, when she actually spent far less. As a result, Medicare reimbursed Reaves more than $511,068 for the fraudulent prolonged service visits Reaves claimed to have made. Reaves faces a maximum potential penalty of 10 years in prison and a fine of the greatest of $250,000 or twice the gross gain or loss caused by her offense. She will also be required to forfeit the proceeds of her crime. Sentencing is currently scheduled for July 13, 2013. Read the rest of the press release at FBI.gov
 By Sy Mukherjee on Feb 11, 2013 at 5:35 pm
In yet another victory against medical fraudsters, federal officials running the Health Care Fraud and Abuse Program have been getting an average of $7.90 in returns for every dollar spent on health care fraud investigations — an all-time record.
As the Huffington Post reports, “the Justice Department opened more than 1,100 criminal health care fraud investigations last year involving 2,148 potential defendants, and over 800 defendants “were convicted of health care fraud-related crimes during the year and the department opened nearly 900 new civil investigations.”
Cutting down on Medicare and other health care fraud has been a top priority for the Obama Administration, and so far their efforts have been paying off. Last year, the Justice Department carried out one of the largest Medicare fraud busts in history, and the agency collected a record $3 billion in settlements from physicians and pharmaceutical companies under the auspices of the False Claims Act last year.
Fraud and abuse is an enormous source of waste in health care spending, with some studies estimating that it accounts for anywhere between a third and half of national health expenditures. Much of the initial projected savings in Obamacare stems from combating fraud — it would appear that, so far, those projections are correct.
 We are pleased to announce that an all-new CPC Exam Review Workshop is now being made available for students of Nancy Enos Medical Coding. Registration is now open for this 1-day workshop that will take place on Saturday, March 23rd from 8am to 3pm.
This workshop is designed to act as a refresher for anyone who took a previous CPC course, or attempted a CPC exam and did not pass. If you are waiting for a re-take and have been putting it off - this Workshop will give you the comprehensive refresher you need to go into your exam with confidence. Not a previous student of Nancy Enos Medical Coding? No problem! The refresher is open to everyone. Just remember to register for the exam on the AAPC website 1 month in advance. So the deadline if you want to take the exam that we will be proctoring on Saturday, March 30th is going to be February 28th.
Even if you aren't waiting to re-take your CPC exam, if you are currently a certified coder who is just looking to brush up on your knowledge and earn a few CEU's, this workshop will offer 6 CEU's at a great value that compares favorably to other workshops available online.
How's this for a special holiday gift for yourself? Still deciding whether or not our January Evaluation & Management Workshop is for you? Perhaps this will help make your decision easier; The AAPC has just approved the Workshop for 14 CEU's! For those of us who have had these CEU's on our Christmas List and have been VERY good this year.... Santa may just leave us these CEU's under our tree. All you have to do is register for our January Evaluation and Management Workshop (more details in the blog post below.)
Every year, Certified Professional Coders are required to continue to develop their professional skills and promote their coding knowledge. These CEU's will go a long way toward ensuring that you meet those requirements. Of note, AAPC made a significant policy change on continuing education units (CEU's) for its specialty coding credential holders this year - AAPC now allows CEUs taken for a specialty credential to ALSO count towards the Certified Professional Coder (CPC) credential. So it' counts TWICE, this is a great value!
Take advantage of this great value, earn your CEU credit hours, and most importantly develop your professional skills to increase your stature and value as an employee.
 Are you ready to advance your career, bolster your resumé, and further enhance your knowledge of correct medical coding and billing? We have been asked with increasing frequency to offer an advanced chart auditing course specializing in Evaluation and Management coding. We are pleased to announce we are now prepared to offer an E/M Boot Camp to familiarize students with advanced chart auditing techniques and prepare them for the Specialty Exams offered by AAPC! As Healthcare Reform puts more emphasis on auditing to make sure that government money is being well spent, there will be an increased emphasis by employers on making sure their coders are properly trained . More and more practices are also hiring external auditors to assist them with their compliance program. By taking the initiative to attain these advanced certifications, you will increase your value as a coder and open up opportunities as a chart auditor or billing compliance specialist for a hospital group, physician practice, consulting firm, or insurance company. This advanced course will take place over two full days: Wednesday, January 23rd and Thursday, January 24th from 8am to 4pm at Kent County Memorial Hospital's Trowbridge building, room 4B. Former students of our CPC course may already be familiar with this room, it has been rated highly as being 'Excellent' in our feedback. It is comfortable, modern, and offers the technology we will need to offer the best possible learning experience. Tuition will be $800 per student (a $100 discount is offered to Kent and Women and Infants PHO members.) The exam will be proctored in the same room on Saturday, January 26th from 8am to 1:40pm. This hands-on workshop with provide an in-depth exposure to the chart auditing process. Students will prepare for the Certified Evaluation and Management Coder Exam. This new preparatory class will focus on actual chart notes to audit with intensive hands-on practical training. Students will review the E/M Key Components of History, Exam (both 1995 and 1997 Marshfield Clinic Guidelines) and audit notes in class to reinforce each of the Key Components. Both instructors ( Nancy Enos, FACMPE,CPC,CPMA,CEMC and Mike Enos, CPC,CPMA,CEMC) have obtained multiple advanced certifications in Evaluation and Management Coding and Chart Auditing, and both also audit charts professionally. As professional instructors, certified coders, and chart auditors they can offer unique blend of practical knowledge and real-world experience you can't find elsewhere. Students will leave with a solid understanding of evaluation and management coding and chart auditing. Don't delay, sign up today!
Ever wonder why the government is spending more and more money on RAC audits and other fraud detection and deterrence initiatives? Each year it seems the Department of Justice and Office of Inspector General uncover more and more shocking examples of fraud and abuse. In the last year alone the feds have arrested con artists who steal Medicare numbers from the elderly in order to submit false claims, doctors that prescribe excessive amounts of controlled substances so they can sell them on the streets, even some who steal federal grant money intended for cancer or autism research. Not only are these acts deplorable and morally reprehensible because they steal money that is intended for the disadvantaged, the poor, and the sick - these criminals cost US Taxpayers $60 Billion (with a B) a year. Tom Costello contributed this report this morning on the Today Show. Be sure to assess your practice for any compliance risks, implement a strong compliance policy, and maintain it. If you uncover any concerns about fraud or abuse, be sure to contact a compliance expert and consider self-disclosure. With the amount of federal dollars being recouped each year (last year alone the federal government recouped $4.5 Billion in fines, penalties, and restitution) you can rest assured that the government will be ramping up its efforts.
Mike Enos, CPC, CPMA, CEMC and Nancy Enos FACMPE CPMA, CEMC, CPC-I, CPC have authored a series of articles published in MGMA's Connexion Magazine. The September issue featured the first part in the Code of Conduct Section, and Part 2 has now been published in the October edition. In the September article EMR Risk- If it wasn't done, don't document it: Tackling E&M coding errors in the age of EHR's we explored the growing trend of overdocumentation made easier by EMR's. We discussed the causes and risks associated with overdocumentation, as well as proper ways of documenting lengthy visits to make sure you are reimbursed appropriately. In this article, we investigate the pitfalls and risks related to overdocumentation and cloned notes specifically. Cloned notes (using the exact same verbage from patient to patient), copied notes, and automatically generated notes should be examined closely, and physicians should be trained on how to delete, correct, and authenticate the contents of their notes to ensure that the notes actually reflect the services provided, and nothing more. Often times in copy-and-paste notes, or other EMR notes where information from previous services are "pulled forward" into the note, we find information that is erroneous, superfluous, and sometimes directly contradictory with what is described in the history of present illness or the examination. EHR's that have a "coding tool" can be especially risky, when the level is calculated based on data elements, and not medical necessity.
Mike Enos, CPC, CPMA, CEMC and Nancy Enos FACMPE CPMA, CEMC, CPC-I, CPC have authored a series of articles published in MGMA's Connexion Magazine. The September issue features the first part in the Code of Conduct Section, and Part 2 will be published in October.
The importance of medical necessity is always the most important component is selection of an E/M level. The features in many EHRs can create auto-text and complete checklists, leading to documentation of elements that were not actually done.
Cloned notes (using the exact same verbage from patient to patient), copied notes, and automatically generated notes should be examined closely, and physicians should be trained on how to delete, correct, and authenticate the contents of their notes to ensure that the notes actually reflect the services provided to a particular patinet, and nothing more.
EHR's that have a "coding tool" can be especially risky, when the level is calculated based on data elements, and not medical necessity.
CMS has approved complex audits of high level E/M services, following their May 2012 Report on improper billing and coding of high level Evaluation and Management Services. Connolly has today posted on their web site their new audit scope related to E&M audits: http://www.connolly.com/healthcare/pages/ApprovedIssues.aspx Impacts: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia, West Virginia.
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