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Artwork for Auditing Antics: Navigating Medical Coding and Auditing

Auditing Antics: Navigating Medical Coding and Auditing

Stephanie Allard Consulting, LLC
Medical Coding
Telehealth
CMS
Centers For Medicare & Medicaid Services
Mental Health
Skin Substitutes
Medical Auditing
Unitedhealthcare
Electronic Medical Records
Auditing
Medical Necessity
Artificial Intelligence
Medicare
Healthcare Compliance
Compliance
E&M Guidelines
Stress
FDA
Wound Care
E/M Coding

Stephanie Allard, CPC, CEMA, RHIT has 20 years of experience in the medical industry and knows the complexities that the professional world is facing on a daily basis. She also knows the lack of public education about our healthcare industry in the United States which contributes to the inability for patients to advocate for themselves. Her Auditing Antics Podcast will explore the healthcare indus... more

PublishesWeeklyEpisodes62Foundeda year ago
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Health & Fitness

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Artwork for Auditing Antics: Navigating Medical Coding and Auditing

Latest Episodes

In this episode of Auditing Antics, we break down the complex world of psychological and neuropsychological testing services from the perspective of documentation, coding accuracy, reimbursement, and compliance risk. We discuss the differences betwee... more

Psychotherapy services continue to be a major focus in behavioral health audits, payer reviews, and documentation denials. In this episode of Auditing Antics, we break down psychotherapy billing from an auditor’s perspective, including what documenta... more

Substance Abuse and Mental Health Services Administration (SAMHSA) www.samhsa.gov/find-helpMay is Mental Health Awareness Month, and this episode of Auditing Antics focuses on the conversations our industry avoids. Medical coding, auditing, a... more

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This episode takes a closer look at one of the most common and dangerous billing issues in healthcare operations: reporting services under the wrong provider’s NPI. What may seem like a simple administrative shortcut can quickly turn into a significa... more

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Recent Guests

Claudia Valdez
Influencer from Cuba referenced in discussion
Episode: Coding the Future: Bridging English and Spanish in Healthcare
Ron Chapman II
Federal criminal defense attorney
Safe Harbor (collaborator)
Episode: When Healing Meets Scrutiny: UPIC Enforcement in Skin Substitutes
Sean Weiss
Healthcare investigator with experience in UPIC matters and SIU engagements
Episode: From Denials to Defense: Surviving Medical Coding Investigations
Eric Rubenstein
Former OIG investigator and health care compliance professional
Episode: From Denials to Defense: Surviving Medical Coding Investigations
Scott Kraft
Medical auditor and colleague at Doctors Management
Doctors Management
Episode: Compliance Fatigue: Why Providers Push Back (And What to Do)
Khush Singh
Dr., clinician with expertise in coding and auditing
Independent clinician / industry expert
Episode: What’s Hiding in Your HCCs? Why RADV Audits Matter More Than You Think

Hosts

Stephanie Allard
Host of Auditing Antics, educator and consultant in medical coding/auditing
Michele
Co-host/guest engaged in interviews, Q&A style discussions, and industry insights related to audits and coding

Reviews

5.0 out of 5 stars from 15 ratings
  • Great Insights for Medical Coding & Auditing Professionals

    I really enjoy Stephanie Allard’s weekly live sessions with Michele. They provide clear explanations of current issues in medical coding, billing, and auditing, along with helpful guidance on avoiding costly billing mistakes. Their discussions are timely, practical, and very relevant for professionals in the revenue cycle and compliance space. Highly recommended for anyone in the industry.

    Apple Podcasts
    5
    adeane75
    United States3 months ago

Top Health & Fitness Podcasts

Talking Points

Recent interactions between the hosts and their guests.

Live Medical Coding, Billing and Compliance Q&A's with Industry Experts
Q: How should we handle an ED consult for psychiatry when the patient is not admitted and the ED code from the ER is no longer reimbursed by many payers?
Use the code set based on where the patient is receiving care (ER setting) and ensure that each provider bills under their own NPI with appropriate taxonomy; CMS allows ER department codes for services matching the description, even if the patient is not admitted, and you should avoid using an office-based code where the service occurred.
What’s Hiding in Your HCCs? Why RADV Audits Matter More Than You Think
Q: How can AI and independent audits improve risk adjustment quality without undermining clinical judgment?
AI can help identify underreporting and overreporting patterns and support evidence-based care plans, while audits must remain independent and data-driven to verify authenticity and relevance of diagnoses.
What’s Hiding in Your HCCs? Why RADV Audits Matter More Than You Think
Q: What common pitfalls do providers and coders face when documenting HCCs?
Common issues include over-reliance on pick lists, treating assessments as a bare list of diagnoses, inadequate documentation of clinical reasoning, and reliance on EMR templates that encourage volume over accuracy.
What’s Hiding in Your HCCs? Why RADV Audits Matter More Than You Think
Q: Why is CMS focusing on RADV audits now, and what has changed in the risk adjustment landscape?
CMS is increasing scrutiny due to concerns about both under- and overreporting of conditions that inflate risk scores and funding, with historical data and OIG findings prompting a stricter enforcement and auditing approach.
Straight Talk on Coding & Compliance: Q&A Edition
Q: Question 5: If a telehealth patient is insured through the state where the provider is located, can the patient be in another state during the visit?
State licensing and legal requirements dictate that the provider must be licensed in the state where the patient is located during the encounter; compact licenses or multi-state licensing arrangements can help, but compliance depends on state rules and patient location.

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Frequently Asked Questions About This Podcast

What is This Podcast about and what kind of topics does it cover?

The show concentrates on practical, ethics- and policy-driven discussions about medical coding, auditing, and healthcare compliance. Across episodes, the hosts tackle real-world challenges such as proper documentation and billing workflows, upcoding risks, payer policy updates, and the evolving role of AI and EMR systems in coding accuracy. There's a recurring emphasis on collaboration between clinicians, coders, auditors, and administrators, with hands-on tips for avoiding common pitfalls, improving governance, and ensuring medical necessity drives appropriate reimbursement. A standout theme is empowering practitioners and office staff with clear workflows, templates, and evidence-based strategies to navigate complex regulatory environment... more

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These podcasts share a similar audience with this podcast:

1. The Compliance Guy
2. CodeCast | Medical Billing and Coding Insights
3. Paint The Medical Picture Podcast
4. Talk Ten Tuesdays
5. Crime Junkie

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this podcast launched a year ago and published 62 episodes to date. You can find more information about this podcast including rankings, audience demographics and engagement in our podcast database.

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Recent guests on this podcast include:

1. Claudia Valdez
2. Ron Chapman II
3. Sean Weiss
4. Eric Rubenstein
5. Scott Kraft
6. Khush Singh

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