Nancy Clements

Recent Posts

Why Quality Documentation Matters

Posted by Nancy Clements on Nov 10, 2021 3:45:00 PM
If you work with provider claims in a medical office, then you have probably heard the phrase, “If it isn’t documented, it wasn’t done.” But a 2020 Center for Medicare and Medicaid Services (CMS) report found that more than 70 percent of claims submitted for payment were paid improperly, meaning something was incomplete or missing from the documentation submitted with a claim.
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Topics: carrier contract guidelines, medical billing, Medicare fraud, medicare compliance, patient billing

Leading Through Change: Virginia Administrator Shares Journey

Posted by Nancy Clements on Sep 17, 2021 10:30:00 AM

Rachel K. Downey, MHA, is an Administrator at Dermatology Associates of Virginia where she has worked for more than six years. Founded in 1969 by Richmond native Charles M. Caravati, Jr., M.D., the practice has grown to 16 Board-certified physicians and four mid-level providers practicing at six central Virginia locations with a goal to excel in quality, patient experience, and cost-effectiveness.

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Topics: medical practice issues, emergency preparedness, financial management, medical office leadership, COVID, change management

Justice Department Announces New COVID-19 Medicare Fraud Enforcements

Posted by Nancy Clements on Jun 9, 2021 9:15:00 AM

The U.S. Department of Justice (DOJ) on May 26 announced law enforcement actions for several COVID-19-related Medicare fraud schemes totaling $143 million. The actions involved the exploitation of Centers for Medicare and Medicaid Services (CMS) policies designed to increase access to care during the COVID-19 pandemic. Fourteen defendants were charged for their actions involving the exploitation of the broadened COVID-19 emergency declaration, telehealth regulations, and rules. 

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Topics: medical office compliance, medical fraud, Medicare fraud, medicare compliance

Telehealth a Lifeline for Medical Practices: Proceed with Caution Say Experts

Posted by Nancy Clements on Apr 14, 2021 11:30:00 AM

Pay careful attention to the latest reimbursement, compliance guidelines, and waivers as you integrate telehealth into patient care, experts warn. As the newness wears off, denials could start rolling in if you aren't watching the updates closely. 

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Topics: Practice management, Practice cash flow, medical office compliance, medical practice issues, medical billing

Practice Managers and Auditors: Learn to Stand Your Ground with Payers

Posted by Nancy Clements on Apr 13, 2021 5:15:06 PM

Changes to healthcare delivery, and billing codes during the pandemic, along with major updates to the E/M documentation guidelines have created a ripe environment for government-contracted auditors. But you have the right to challenge auditors. Take steps now to establish your culture of compliance.

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Topics: Practice cash flow, payer contract, carrier contract guidelines, medical office, medical billing, financial management, auditing

Practice Transformation Coach Debbie Rozanski Shares Tips to Beat Stress & Gain Confidence

Posted by Nancy Clements on Mar 25, 2021 11:01:16 AM

When demands at work leave you overwhelmed or exhausted, knowing where to turn for support is important before stress builds and spreads into other areas of your life. Relief starts with giving up some control, said Practice Transformation Coach Debbie Rozanski.

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Topics: Practice management, medical office certification, Certified Medical Office Manager, medical practice issues, administrative burdens

Perseverance Through Change: Practice Manager Ashton Ardila's Journey

Posted by Nancy Clements on Mar 16, 2021 3:41:30 PM

Your Family Doktors, a 25-year-old family practice in Webster, TX, faced many operational challenges over the past year as the COVID-19 pandemic sent healthcare into a tailspin. Office Manager Ashton Ardila, CMOM, CMIS, shared some of the hurdles and frustrations her team faced, and how the practice has persevered.

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Topics: Practice management, CMOM, medical office certification, Certified Medical Office Manager, medical office manager topics, medical office compliance, medical office staff, administrative burdens

Education and Hard Work Have Helped Elizabeth Daley Set a Strong Foundation for Career Growth

Posted by Nancy Clements on Mar 10, 2021 12:39:18 PM

Elizabeth Daley, MHA, CMIS, CMOM, CMCO, is Director of Client Success at Collect Rx, a 15-year-old company launched by former executives from third-party vendors who pioneered the out-of-network (OON) industry. The company works with 2,100 clients across the country and have built a proprietary database with thousands of claim resolutions at their fingertips to facilitate and expedite the negotiation process.

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Topics: Practice cash flow, value proposition, carrier contract guidelines, medical practice issues, medical billing, financial management

PMI Certification Renewal Questions Answered

Posted by Nancy Clements on Jan 7, 2021 12:45:00 PM

This time of year, we get a lot of questions from certified professionals about keeping their credentials current. The good news is the process is not too complex. And, with a little pre-planning, renewing your certification(s) can be quick and easy.

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Topics: PMI Certification, medical office certification, medical office staff

Relaxing of the PHI Protections Introduced for Public Comment

Posted by Nancy Clements on Jan 5, 2021 9:07:34 PM

The Department of Health and Human Services (HHS) this week submitted a 357-page proposal for publication to the Federal Register detailing proposed changes to the Privacy Rule under the HIPAA & HITECH Act standards.

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Topics: medical office compliance, HIPAA, administrative burdens

HCC Coding Guidelines and Their Impact on Medical Practice Revenue

Posted by Nancy Clements on Jan 4, 2021 12:31:13 PM

Is your practice accurately reporting the severity of illness for Medicare patients? If chronic conditions are not documented and coded annually, the health status of your patients is not accurately reflected in their care. 

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Evaluation and Management Services Will See Big Changes in 2021

Posted by Nancy Clements on Aug 5, 2020 4:00:00 PM

The Centers for Medicare and Medicaid Services’ recently announced that Evaluation and Management (E/M) visits will soon get some relief from burdensome coding and billing requirements. These billing and documentation requirements for E/M codes were established 20 years ago and have been subject to longstanding criticism from clinicians that they do not reflect current care practices and needs.

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Topics: E/M coding, medical coding, evaluation and management

Pain Management: How Health Care Providers Can Curb the Opioid Addiction Crisis - Join the CMS Discussion

Posted by Nancy Clements on Sep 10, 2019 3:15:27 PM

For health care professionals, opioid addiction is a complex problem that requires careful physician monitoring because of the dangerous side effects. The Federal government has issued safety warnings and guidance for physicians to address the opioid crisis. Earlier this year, the U.S. Food and Drug Administration issued a warning to physicians and health care professionals not to abruptly discontinue opioids in patients who are dependent. The FDA also required label changes to guide prescribers on gradual, individualized tapering.

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Topics: Pain Management, Opioid Addiction

Why We Host: Interview with Lindsay Usher, Northern California Medical Associates

Posted by Nancy Clements on Jul 31, 2019 9:31:25 AM

Northern California Medical Associates (NCMA) has been a leading association of medical practitioners in the North Bay Area since 1975, when Cardiology Associates of Santa Rosa, Inc. first opened its doors. Since then, NCMA has expanded its expertise and scope of care by merging with several private practices to better serve patients in Sonoma, Mendocino and Lake counties.

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Topics: Practice management, Certified Medical Office Manager, medical office manager topics, quality assurance, staff recruiting

Sexual Harassment Prevention in a Medical Office

Posted by Nancy Clements on Apr 2, 2019 3:05:40 PM

When sexual harassment is taking place in a medical practice, it can have devastating effects. Every office should have a strict protocol for addressing claims. Alleged victims need to know that their claims are taken seriously and will be fully investigated, says Michelle Goodwine, CEO, Diversity Advice Consultants.

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Topics: Practice management