Retrospective Coding Gone Wrong Documentation, HCCs & False Claims Act

Medical Coding Salary Expectations: Real Talk for 2026 What do entry-level coders earn?Does certification increase salary?Which specialties offer higher earning potential?Do remote coding jobs pay more?How do you negotiate a better offer? Laureen Jandroep breaks down the numbers and shares practical career advice. This episode is from the CCO Podcast #1747 webinar. Watch the full video here: https://youtu.be/iZQ2t1FaaUE

What happens when billing asks you to change a diagnosis, utilization review requests a status change, or finance wants accounts released before provider queries are answered? In this episode, Laureen Jandroep explains how medical coders collaborate with billing, UR, and finance teams while protecting coding accuracy and compliance. Learn about: Billing editsCondition Code 44Observation servicesDNFBCase Mix Index And the importance of staying within your professional responsibilities. This episode is from the CCO Podcast #1752 webinar. Watch the full video here: https://youtu.be/YfYm1sMIlnA

From Bedside Nurse to Medical Coder: Is It Possible? Thinking about leaving bedside nursing but still want to use your clinical expertise? Alicia Scott explains: Why nurses make strong coding candidatesWhich certifications to considerWhat coding exams requireSalary and career opportunitiesCDI and HIM career pathsHow to prepare for the transition This episode is from the CCO Podcast #1747 webinar. Watch the full video here: https://youtu.be/UWh0NeoXdeY

Are outdated CPT codes, modifier errors, and claim denials slowing you down? Alicia Scott shares practical fixes for: ✅ Modifier 25 ✅ E/M coding ✅ NCCI edits ✅ Telehealth billing ✅ Prior authorization ✅ AI coding mistakes ✅ Denial management This episode is from the CCO Podcast #1752 webinar. Watch the full video here: https://youtu.be/q60V7ZzqXkk

Can you bill both procedures? Can modifier 59 override the edit? In this episode, Laureen Jandroep explains: NCCI PTP edits Column 1 vs. Column 2 Modifier indicators 0, 1 and 9 CMS and Find-A-Code lookups Modifier 59 and X modifiers MUE limits and appeals Ophthalmology coding examples Don't let an outdated edit or unsupported modifier create an avoidable denial! This episode is from the CCO Club Q&A #1741 webinar. Watch the full video here: https://youtu.be/NtzFyPGt3Lo

BI-RADS & Breast Density Coding: Are You Choosing the Right ICD-10-CM Code? A BI-RADS letter is NOT your diagnosis code! In this episode, Alicia Scott explains how to interpret breast density statements, navigate R92.3 codes, apply laterality, and avoid common mammography billing mistakes. You'll also learn about: FDA reporting vs. CMS billingBillable vs. nonbillable codesMedicare's 11-month screening ruleDense breast tissue and supplemental imaging coverage This episode is from the CCO Club Q&A #1741 webinar. Watch the full video here: https://youtu.be/R9Th7noOTMA

What happens when the physician documents a precise anatomical structure, but you can't find that term in your coding manual? In this episode, Alicia Scott uses the basal ganglia to demonstrate how anatomy is organized differently across ICD-10-CM, CPT, and Medicare coverage policies. You'll learn: Why searching anatomical terms alone can lead to confusing resultsHow I61, I63, S06.3, and G23 organize diagnoses differentlyHow to distinguish subcortical and cortical hemorrhageWhen to consider I61.0, I61.1, I61.2, and I63.81Why mechanism and vessel matter in cerebral infarction codingHow to navigate the CPT Index for brain proceduresWhy coverage policies and procedure codes serve different purposesHow documentation queries can help improve specificity Discover a practical research technique that applies well beyond neurology. This episode is from the CCO Community #1762 webinar. Watch the full video here: https://youtu.be/Fu6tmeQHw7I

Does a dangerous medication automatically make an E/M encounter high risk? In this episode, Alicia Scott explains the two independent drug-related high-risk examples in the E/M risk column, the requirements for intensive toxicity monitoring, decisions involving parenteral controlled substances, and why IV administration alone doesn't establish high risk. You'll learn: ✔ Moderate vs. high-risk drug management ✔ Intensive monitoring for toxicity ✔ The four-gate monitoring framework ✔ Monitoring for harm vs. therapeutic effect ✔ Parenteral controlled substance decisions ✔ Insulin, diuretic, and antineoplastic examples ✔ Why high risk doesn't automatically mean high MDM This episode is from the CCO Community Q&A #1762 webinar. Watch the full video here: https://youtu.be/yvh9ZVQsO7A

A diagnosis can be accurate—and still fail to support a claim if the documentation underneath it doesn't meet applicable requirements. In this episode, Alicia Scott examines retrospective HCC coding through the lens of a major settlement involving allegations about medical-record amendments and risk adjustment data. The discussion focuses on documentation provenance, amendment requirements, provider involvement, add-only reviews, audit trails, HCC models, and workflow design. You'll learn: The Identify–Attribute–Preserve testEHR amendment and audit-trail considerationsWhy provider sign-off isn't the whole analysisRisks of add-only retrospective reviewsHCC model/date-of-service considerationsAudit extrapolation conceptsFive project-design questionsWhat to do when you identify a concern This episode is from the CCO Podcast #1751 webinar. Watch the full video here: https://youtu.be/OQPXZ6miyw0

Trying to break into healthcare revenue cycle but don't know where to start? In this episode, Alicia Scott explains the five stages of revenue cycle, professional vs. institutional claims, common transaction numbers, rejected vs. denied claims, important KPIs, entry-level job opportunities, and credentials that can help you build your career. You'll learn: The five stages of revenue cycleWhere beginners can enter the fieldCMS-1500 vs. UB-04837P vs. 837ICommon transaction numbersRejections vs. denialsRevenue cycle KPIsEntry-level job titlesRevenue cycle credentials This episode is from the  CCO Podcast #1751 webinar. Watch the full video here: https://youtu.be/2--io3qRajw