Auditing Antics: Navigating Medical Coding and Auditing

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, cod...

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.

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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...

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!

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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 aud...

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.

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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.

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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...

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/contact

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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 d...

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 c...

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/

Join us for the first episode in a series related to medical documentation and coding policies and the role they play within a compliance program as a whole and to offer structure for consistency and adherence to guidelines. Creating policies is not just about checking a box to say it is present and complete. Instead, it is about building a strong foundation for compliance and organizational integrity.

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Coding for critical care services is not dictated based on diagnosis, practitioner specialty and/or the setting/unit where the patient is seen. So what supports compliant documentation for billing of critical care services? Join us during this episode as we dive into the coding guidelines and discuss common struggles we face when coding, auditing and educating in this specialty. Sign up for our updates and the latest compliance new...

With the Recent Extension What Does Telehealth Look Like Through September of 2025? While 5 months seems like a long time, developing a contingency plan now will allow your practice to quickly pivot if the regulatory environment should change after the extension period expires. Stay informed!

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During this episode we will discuss why the routine waiver of co-pays and out-of-pocket costs is problematic when not handled correctly internally. Depending on the actions taken by the organization this can even be considered illegal violating the False Claims Act. Join us to learn more about running this side of an organization and the policies you need to have in place to ensure compliance.Sign up for our newsletter here!

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So many organizations are focusing on the financial side of incident-to and not investing enough time and attention to fully understand and ensure compliance. During this episode we will look beyond the 100% reimbursement of the physician fee schedule and uncover the complexities that practices are facing through the typical workflow that does not coincide with incident-to.

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The coding and billing workflow is not only about getting claims out the door. Too many organizations do not have a strong focus on the "backend" and denial management. This can cripple the revenue of a practice. During this episode, we will discuss the various types of structures for a medical organization's billing team internally and/or externally. We will review steps and tips to stay on top of the volume and work...