The Cigna Group will pay $172 million to resolve False Claims Act allegations. The U.S. Department of Justice (DOJ) announced Sept. 30 that The Cigna Group, which owns and operates Medicare Advantage (MA) organizations that offer MA plans to beneficiaries across the country, has agreed to pay $172,294,350 to resolve allegations that it violated the […] The post DOJ Penalizes Cigna for Inaccurate Diagnosis Codes appeared first on AAPC Knowledge Center ..read more

AAPC member Rosa Yanez, CPC, CRC, CGIC, CGSC, has been a medical coder for 15 years and has worked for Humana as a senior Medicare risk adjustment educator for more than two years. “Risk adjustment education is new to me, but I absolutely love it,” says Yanez. “I love helping providers be successful coders.” AAPC […] The post Advice From a CGIC™ appeared first on AAPC Knowledge Center ..read more

Understanding the rules surrounding interrupted stays in IPFs and IRFs is as easy as 1-2-3. When an interrupted stay occurs in an inpatient psychiatric facility (IPF) or inpatient rehab facility (IRF), a compliant claim using a UB-04 form must be submitted. The facility must submit one claim for the entire length of stay using billing […] The post Counting the Days for Interrupted Stays appeared first on AAPC Knowledge Center ..read more

Embrace DEI data in applied behavior analysis and improve patient care for all. In the realm of healthcare, the field of applied behavior analysis (ABA) has long been committed to understanding and improving behaviors in individuals to foster positive care outcomes. A challenge has emerged in this method, however: the limited consideration of diversity, equity, […] The post Cultivate a Culturally Compassionate Practice appeared first on AAPC Knowledge Center ..read more

Know the rules for compliance before engaging in telehealth services. One of the things we love most about the internet is its unregulated nature. We post and share whatever we want, achieving unprecedented freedom of speech. But everything changes when it comes to personal and sensitive information like medical records. Considering the popularity and convenience […] The post HIPAA Guidelines for Telemedicine appeared first on AAPC Knowledge Center ..read more

The Medicare Advantage organization says they are being held to unreasonable standards. Health Net of California, Inc. was recently called out by the Office of Inspector General (OIG) for failing to submit “some” diagnosis codes to the Centers for Medicare & Medicaid Services (CMS) for risk adjustment in accordance with federal regulations. Based on audit […] The post OIG Says Health Net Misreported Dx Codes appeared first on AAPC Knowledge Center ..read more

Reduce the clutter on your home page with one click. Codify offers a lot of tools on its home page, but you don’t always want all of them expanded at once. There is a simple way to maximize the tools you’re using and minimize the others. To minimize a tool so you see only its […] The post Minimize and Maximize Widgets to Customize Codify appeared first on AAPC Knowledge Center ..read more

Strategies for unlocking a dialogue with physicians. As auditors, we bridge the gap between medical coding accuracy and financial stability in healthcare organizations. It’s our role to “knock on the doors” of financial insights. Imagine standing before a majestic doorway, its imposing presence symbolizing the weighty responsibility of financial insight. Crafted from solid oak, the […] The post Exploring the Financial Impact of Audits appeared first on AAPC Knowledge Center ..read more

Encourage patients to take stock of their relationship with alcohol. From Dry January and Dry July to Sober September and Sober October, the month-long abstinence trend of shunning alcohol has gained ground in recent years. The practice touts better sleep, improved memory, clearer skin, better immune function, increased energy, and lower blood pressure and cholesterol […] The post Go Sober for October appeared first on AAPC Knowledge Center ..read more

Meet a member who never stops learning and growing. Each month, AAPC selects a member who demonstrates exemplary leadership qualities. This month, we’ve chosen Jennifer Lavoie, RN, CPC. Lavoie has enjoyed a remarkable journey in healthcare from her work as a registered nurse (RN) to her current position as director of revenue integrity for a […] The post Member of the Month: Jennifer Lavoie appeared first on AAPC Knowledge Center ..read more