We have seen the transportation industry rapidly transform in just 5 short years. Lyft made history this summer by landing the first state Medicaid contract with Arizona's Medicaid program for ride-sharing services in the country. And Lyft just landed 5 new state Medicaid Contracts with Georgia, Michigan, Tennessee, Virginia, and Misssouri. Lyft's reach will continue to expand as the demand for these services explodes. The social determinants of health (SDOH) diagnosis c

Ever wondered how much clout your Medicare Administrative Contractor (MAC) actually has? I get this question A LOT: My MAC doesn't have an established policy on XYZ issue, but another MAC does - can I use it? The answer is yes and no. David's article does an incredible job of providing real-world legal insight to this question. However, when it is all said and done, a MAC policy does not have the same effect as a regulation or statute. It is simply a starting point. #M

Nearly 1 in 3 Medicare patients are enrolled in a Medicare Advantage plan. These plans are often administered by private insurance companies. Risk adjustment data validation (RADV) audits reveal that billions of dollars are fraudulently billed by Medicare Advantage health plans each year. These upcoding practices are so rampant that Kaiser Health News is suing Centers for Medicare & Medicaid Services (CMS) for the audit results that support these claims. CMS officials sta

Conducting regular coding audits and education are essential components to a healthy compliance program. Coding audits are hands down one of the best investments any practice, hospital, or health system can make. The return on investment (ROI) is infinite. And with ADRs, payer audits, and RAC audits on the rise, you simply cannot afford to ignore this area any longer. I am shocked by how many professionals remain unaware that regular audits are mandated by the Patient Pro

I am routinely asked which coding certification is more valuable: AAPC or AHIMA? The answer to this question is highly personal and contingent on your long-term career goals. Both organizations (AAPC and AHIMA) are the gold standard for the medical coding profession. Historically, AAPC has served the outpatient side of medicine and AHIMA has served the inpatient side. However, in recent years we have seen both organizations make strides to appeal to both outpatient and i

Emotional Intelligence (EQ) is one of the most sought after skills in today's job market. EQ is your ability to purposefully understand, manage, and navigate your emotions and the emotions of others around you. Hiring Managers and C-Suite Executives often state EQ is much more valuable than IQ. Investing in your EQ will pay substantial dividends over time! #MedicalCoding #MedicalBilling #Compliance #Revenue #RevenueCycle #RevenueCycleManagement #AlphaCodingExperts #AAPC #A

Claims denial management (CDM) is the hot topic of every healthcare organization. How can we send cleaner claims, reduce denials, decrease days in A/R, and work more efficiently? Through a rigorous internal audit, root causes to your most complex issues can be identified. Below are 8 strategies to promote a more efficient CDM process. #MedicalCoding #MedicalBilling #Compliance #Revenue #RevenueCycle #RevenueCycleManagement #AlphaCodingExperts #AAPC #AHIMA #Coders #Physici

Alpha Coding Experts is proud to announce that our CEO, Toni Elhoms, was elected as the 2020 AAPC Orlando Chapter Secretary. As Toni states: "This is a huge honor and I am proud to serve our membership alongside my fellow board members. With over 1200+ members, the Orlando Chapter is one of the largest AAPC Chapters in the United States. 2020 is going to be an epic year for our members! Thank you again for this opportunity." For more information about the Orlando AAPC Cha

EHR systems without proper oversight create many systemic problems for organizations and specifically providers. Errors in medical record documentation can surface in medical malpractice suits such as the instances detailed in Terry's article. The DOJ continues to put EHR systems on high alert regarding violations of the False Claims Act (FCA), meaningful use, copy forward functionality, etc. EHR systems can be great tools, but must be used with caution! #MedicalCoding #Med

There are epic changes on the horizon for Stark Law and the Anti-Kickback Statute as officials attempt to modernize regulations. Many would argue that these efforts are long over-due as we dive deeper into value-based care. The hoops providers have to jump through to properly coordinate patient care reflects unnecessary red tape in our healthcare system. Providers are highly encouraged to contact their professional associations and voice their comments regarding these regu