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Caral Edelberg's Interview for Top 10 Compliance Solutions Award- 2018

  Edelberg & Associates A New Era in the Medical Coding Landscape A well-regarded medical coding expert, sought after healthcare compliance educator, and a frequent speaker and author on healthcare management topics, Caral Edelberg—a thought-leader in the healthcare landscape for more than four decades—executes each of these variegated roles with finesse... To read in magazine,…

Edelberg makes Top 10 Healthcare Compliance Solutions- 2018 by Healthcare Tech Outlook!

Edelberg & Associates is thrilled to be named to Healthcare Tech Outlook magazine’s 2018 Top 10 Healthcare Compliance solutions.  Healthcare Teach Outlooks list is an exclusive ranking of the nation’s top healthcare compliance solutions. Complete results of the Healthcare Tech Outlook magazine’s 2018 Top 10 Healthcare Compliance solutions, including company profiles can be found at www.healthcaretechoutlook.com. Interview with Caral…

Hospital Observation Services and 2017 “MOON” Requirements

Hospital Observation services have received much attention in past years as a result of issues relating to patient confusion about co-pays and charges for Medicare outpatient vs. inpatient services. In an effort to address these issues, CMS has developed the “Medicare Outpatient Observation Notice” (MOON) effective for dates of service beginning February 21, 2017 under CMS-10611 Transmittal 3695 dated January 20, 2017.

Critical Care in 2017

Some Thoughts to Improve Documentation and Assure Correct Coding Determining what constitutes critical continues to stump physicians and coding professionals into 2017.  As a result, determining Critical Care for professional and technical services still remains a subjective area of E/M coding.  Although CMS has attempted to clarify the content and determining factors for critical care…

MLN Updates

[vc_row][vc_column width="1/1"] Stay Up to Date on Medicare + More with MLN Matters® The experts at Edelberg + Associates are dedicated to keeping the coding community up to speed on changes within the industry. One resource we rely on is the MLN Matters® Articles published by the Centers for Medicare & Medicaid Services. The new…

If It Wasn’t Documented — It Wasn’t Done

From the E+A Experts — What to Know when Scoring Records for “Medical Necessity”   Defining “Medical Necessity” for Documentation All services provided to a patient who is receiving Medicare are subjected to Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This act demands that services meet a set criteria to be deemed “reasonable…

NOW HIRING: Remote Pro-Fee Coders

The top team in medical coding is hiring! The E+A remote team has immediate openings for 
E/M-Hospitalist Pro-Fee Coders AND ED Professional and/or Technical Coders. As a member of the E+A team, you set your own flexible schedule but MUST commit to at least 15 hours per week. You will be taxed as a long-term…

Learn About E+A Emergency Medicine Coding Audits

Struggling to Find Compliance Issues and Revenue Leaks? We Can Help! At Edelberg + Associates, we’ve made our name by delivering superior service and unparalleled accuracy to our physician and hospital clients who manage healthcare revenue cycles and reimbursement. The expertise of E+A’s medical coders also helps these organizations stay compliant, even amidst continually-shifting regulations.…

Top List of Medical Coding Credentials

If you’re new to the medical coding field, medical coding certifications can seem like an alphabet soup of education. Those unfamiliar with the field and its different coding credentials may find themselves bewildered about which can help them attain a promising future in coding. The reality is that the coding credentials you should pursue should…

The Top 10 Medical Coder Must-Haves

As a rapidly growing field with new opportunities on the horizon every day, medical coding is a terrific job for people who enjoy challenging and rewarding work paired with schedule flexibility. Since a good majority of medical coding is remote, coders can do the job from anywhere with an internet connection. If you’re looking to…

Enjoying #AHIMACon15!

Our team had a blast at the 2015 AHIMA Convention this week in New Orleans!  We met some great people at our booth and our shirts were a big hit.  Thanks to everyone who stopped by to visit with us during the show.

Edelberg makes Inc. 5000 List for the 2nd time!

Edelberg & Associates is thrilled to be named to Inc. magazine’s 34th annual Inc. 5000, an exclusive ranking of the nation's fastest-growing private companies. Edelberg & Associates achieved an impressive three-year growth of 517% and ranked NO. 863 on the list. The list represents the most comprehensive look at the most important segment of the economy—America’s…

Edelberg makes Top 20 Healthcare Compliance Solution Providers List!

Edelberg & Associates received top honors by being selected in Healthcare Tech Outlook Magazine's Top 20 Healthcare Compliance Solution Providers!   Edelberg & Associates was selected as on of the top companies who are at the forefront of tackling industry challenges from a distinguished panel compromising of CEO’s, CIO’s, VC’s and analysts including Healthcare Tech…

Edelberg Featured in AAPC Healthcare Business Monthly!

Our own Lee Williams, RHIT, CPCO, CPC, CCS, CCDS, Director of Coding Operations wrote an article in the July issue of the AAPC Healthcare Business Monthly. Here is an excerpt from the article that appears on Page 40 of the magazine: Is Your Next Step Inpatient Coding? Compare it with outpatient coding, and if the show…

As Seen in Forbes!

We are thrilled that our CEO, Caral Edelberg, was featured in the June issue of Forbes Magazine. Check out her profile that was included in the Southeastern Women Business Leaders feature.  This is quite an honor! Click here to see the profile

ACEP 2014 - What a Show!

Thanks to all of our current clients, friends, acquaintances and others whom we met at the ACEP 14' show in Chicago, Illinois. It was a record turn-out for this year's event which was held at McCormick Place from October 27 to October 29, 2014. Nearly 8000 attendees were present from all corners of the Earth.…

Edelberg Featured in ACEP Now June 2014 Issue

In a recently released article from ACEP entitled "Healthcare Professionals Share Insights on Challenges, Future of Emergency Medicine", an all-star cast of luminaries in Emergency Medicine, including our very own Caral Edelberg, discuss the challenges ahead for Emergency Medicine and also share their unique insights built over their many decades in the industry.  The article…

Ambulance and EMS Transport Medical Coding: Cheat Sheet and Tips

Emergency situations call for unique medical coding of non-physician provider services Ambulance codes and guidelines are uniquely applicable to non-physician providers. To make coding these services even more of a challenge, procedure codes relevant to emergency medical service (EMS) providers aren't found in the CPT® codebook. Instead, coding guidelines for ambulance and EMS transport codes…

Congressional Budget Office Releases New Estimates on Impact of ACA

Interesting information was just published this week from the Congressional Budget Office which cites what are the believed impacts resulting from the monumental changes occurring in the US healthcare marketplace.   As an organization we are smart enough to stay out of the politics of healthcare and the ensuing heated debates.  Just like your mother's…

7 Tips to Prepare You and Your Provider Organization for ICD-10

It seems these days that you can hardly go to any conference, trade publication or industry soiree without hearing ICD-10 chatter fluttering about. Even though many of us have grown weary of the talk it is a fact of life that will soon be affecting any of us that deal in the world of healthcare…

Medical Necessity = Key Trend in Increased Audits

In case you missed it, Caral Edelberg was cited in a recent article on ACEP News regarding trends in Medicare audits for providers and tips on how healthcare entities can ensure they are covering all their bases when it comes to proper documentation and identification of medical necessity.   Thanks ACEP for continuing to be…

Sequestration's Impact on Healthcare Providers Set to Take Hold

Unfortunately, it seems the sequestration's impact will now be felt on healthcare providers.  Beginning on April 1st, 2013 and for DOS on or after 4/1/2013 Medicare will be reimbursing at a 2 percent lower rate. Approximately 90% of the Medicare program will be capped at a 2 percent reduction with the other 10% not experiencing…

Opportunity for Big Data in Healthcare Revenue Cycle Operations is Enormous (ACEP Reimbursement & Coding Conference Take-Away)

Edelberg & Associates concluded an excellent conference week in San Diego on February 7, 2013.  It is always exciting to meet with our friends, colleagues, partners and practices in the healthcare arena.  This conference was no different and featured equal parts education, networking and great conversations with thought leaders and decision makers in the emergency…

Caral Edelberg Speaks at Straight Talk Reimbursement Conference

Edelberg & Associates is pleased to be a gold sponsor of the Michigan Chapter ACEP conference on Emergency Medicine Reimbursement Issues taking place on November 12, 2012 at the Lexington Hotel in Lansing, Michigan. President & CEO of Edelberg & Associates, Caral Edelberg, will be speaking to attendees about some of the most pressing issues…

Important Update from Caral Edelberg, President, Edelberg & Associates

A Letter From Caral Edelberg, President APRIL 2, 2012 Dear Friends, Colleagues and Partners, As we look to a new spring season with growth, possibility and change abounding, we also see a metaphor for the industry that we all love. In the current expansion and change taking place in the healthcare world we see a…

Documentation Tips for Hospitalists

Great comments for documentation: -Review of prior records should be documented. -For higher acuity levels, the ROS (Review of Systems) should include a review of 10 or more systems or note that all others were reviewed and negative. -Separate the ROS statement from the HPI. -Address those systems with positive findings individually. -Physicians should note…

Documenting & Billing Critical Care for OPPS

Documentation and billing for the hospital component of ED critical care continue to present a challenge for hospitals as the rules, based somewhat on CPT but with a twist added by the Centers for Medicare & Medicaid Services (CMS), differ enough from the professional rules to create a significant challenge. Beginning January 1, 2007, critical…

Minimizing EMS and Ambulance Audit Risk

Ambulance and EMS billing require the same level of compliance and accurate code submission as hospitals and medical practices. As Medicare expands its audits of ambulance billing, risk controls are critical. However, due to the differences between physician/hospital coding rules and those established for ambulance/EMS, many ambulance companies increase their audit risk with every transport.…

Caral Quoted in "Coding Newsletter"

Caral Edelberg, President & CEO, is often referenced throughout the industry in regards to practices and new techniques that can be adopted by coding personnel and the broader revenue cycle function.  One such article references procedures that can be taken for Emergency Department Coding to account for a critical care scenario. Emergency Coders: Check for…

Properly Documenting Medical Decision Making

Here are just a few helpful tips for properly documenting MDM List your impressions and differential diagnoses Document review of current meds and medication reconciliation Document medical care provided prior to patient's arrival (e.g. EMS) Note information obtained from sources other than the patient (parent, guardian, relative, caregiver, nursing home) List all interventions and procedures,…

Facility Updates for 2011 Where Can You Tighten Up for Added Revenue?!

ED volumes continue to climb, joblessness combined with the economic downturn promise to make it a challenging year for hospitals. There is a lot of emphasis on patient satisfaction, safety and security and each require resources to manage effectively. However, for our EDs, as visits soar and payment bottoms out, we need to assure we…