Stephanie Allard Consulting, LLC

This weekend, Michele and I traded audit reports and payer policies for a road trip to beautiful Beaufort, South Carolina, to spend some much-needed time with family.

As much as we love what we do through Auditing Antics Podcast and our healthcare compliance work, these moments serve as an important reminder that life exists outside of deadlines, denials, and documentation reviews. One thing high on our bucket list this summer is taking more road trips to visit family, reconnect, make memories, and enjoy the journey along the way.

Work is important, but so are the people who support us behind the scenes. Grateful for the opportunity to step away for a few days, enjoy the charm of Beaufort, and spend quality time with those who matter most.

Thank you to the National Society of Certified Healthcare Business Consultants (NSCHBC) for the invitation to speak at the Annual Conference in Cleveland, Ohio. It was great to join so many consultants and healthcare professionals to discuss some of the most pressing issues impacting our healthcare coding and billing industry today.

My session focused on hot topics and healthcare updates affecting providers, coders, billers, compliance professionals, and consultants. One of the key discussions centered around the growing trend of payer auto-downcoding of E/M services and the increasing use of algorithms to reduce reimbursement without a clinical review of the medical record.

Ironically, shortly after our discussion, Blue Cross Blue Shield of Illinois announced that beginning July 1st they will also implement downcoding practices. This means we now have yet another payer publicly acknowledging that E/M services may be reduced based on automated assumptions rather than an actual review of the provider's documentation.

The most concerning aspect of these programs is that the payer has not reviewed the medical note, evaluated the physician's medical decision making, or assessed the complexity of the encounter. Instead, assumptions are being made based on diagnosis codes that cannot fully capture the work performed, the risk addressed, or the clinical judgment required during a patient encounter.

The AMA E/M guidelines were specifically designed to allow providers to select service levels based on the documented work performed and the complexity of MDM. When payers substitute automated assumptions for documentation review, they create a process that conflicts with the intent of those guidelines and raises important questions about transparency, fairness, and provider reimbursement.

Thank you again to NSCHBC for providing a platform to discuss these critical issues. The conversation is far from over, and it is more important than ever for healthcare professionals to understand how these policies may impact their organizations and their patients.

I have seen multiple social media videos this week of patients that are realizing what AI Ambient Scribing is and the tone of the videos have been shock and a misunderstanding how this is something that would be acceptable in healthcare.

When I watch videos like this it makes me wonder how many patients are actually aware of how AI is being implemented into the industry and how that is going to impact them directly. While we cannot stop the evolution of AI we have to remember that there are certain components that are going to require full transparency with patients and they have the autonomy to decide how they want AI to be a part of the encounter and relationship with their provider.

As AI ambient scribes become more common in healthcare, patients are starting to ask important questions:

"Who is listening to my appointment?"
"Where is my information being stored?"
"Who has access to those recordings?"
"Was I told AI was being used?"

For years, conversations between patients and providers were documented by the provider or a member of the care team. Today, many organizations are introducing technology that can listen, transcribe, summarize, and generate medical documentation in real time.

While these tools may improve efficiency, patients are becoming increasingly aware that their healthcare conversations may be processed by artificial intelligence systems and with that awareness comes concern.

Patients want transparency. They want to understand how their information is being used, whether conversations are being recorded, how long data is retained, and what safeguards are in place to protect their privacy.

Healthcare organizations should not assume that patients are comfortable with AI simply because the technology is available. Trust remains one of the most important components of healthcare, and trust requires clear communication.

As the industry continues to adopt AI-powered documentation tools, privacy, consent, security, and transparency need to remain at the center of the conversation. The question is no longer whether AI will be used in healthcare.

The question is whether patients fully understand when it is being used and what that means for their personal health information.

I have been thinking a lot lately about the future of healthcare coding and auditing and whether our industry is truly preparing people for where things are heading.

The reality is that healthcare is changing rapidly. AI, automation, payer scrutiny, compliance pressures, and operational changes are already impacting coding, auditing, and revenue cycle workflows. I think many professionals are asking themselves an important question right now:

What do I need to do to remain relevant in the future?

Read the latest article here:
https://www.stephanieallardconsulting.com/articles/healthcare-coding-credentials-alone-are-not-a-career-plan

Memorial Day is more than a long weekend. It is a time to remember and honor the brave men and women who gave their lives in service to our country.

Today, I also think about family and friends we have lost who proudly served. Their sacrifice, strength, and dedication will never be forgotten. The impact they made continues to live on through the people who loved them and the freedoms we enjoy every day.

Take a moment today to remember those who served, those we lost too soon, and the those who continue to carry their memory forward. ❤️🤍💙

Today we celebrate National Medical Coder Day 🎉

Behind every accurate claim, compliant record, audit-ready chart, and properly supported reimbursement is a medical coder making it happen every single day.

Medical coders do far more than assign codes. They help connect documentation to patient care, support compliance, reduce risk, and keep healthcare moving forward.

Thank you to all the medical coders, auditors, educators, billers, and compliance professionals who bring precision, knowledge, and dedication to this industry every day. Your work matters and your impact is seen. 💙

Happy National Medical Coder Day from Stephanie Allard Consulting, LLC ✨

🚨 Staying current in medical coding and compliance is not getting easier. Regulations change quickly, payer scrutiny continues to increase, and audit risk is everywhere. That is exactly why the Coding Compliance Connection Membership was created.

Members receive unlimited monthly access to ask the expert, live Q&A sessions for coding, compliance, and mentorship support, audit tools, on-demand webinars, a 2026 Telehealth Planning Guide, and access to a professional book club focused on growth within the healthcare industry.

This membership is designed to provide practical, real-world support that helps coding professionals, auditors, billers, consultants, and healthcare organizations stay informed, prepared, and confident in their day-to-day work.

If you are looking for ongoing education, compliance guidance, mentorship, and resources all in one place, the Coding Compliance Connection Membership is built for you.

📍 Check out our membership here! https://www.stephanieallardconsulting.com/membership

Behavioral health providers are actively discussing reports that Alma providers may see certain Aetna claims reimburse CPT 90837 the same as 90834 effective July 15, 2026 despite the recognized psychotherapy time difference.

This could have major implications for:
• Documentation and audit risk
• Patient access and care
• Provider workflow
• Practice sustainability

I wrote an opinion article discussing the concerns many providers are raising and what this could potentially signal for the future of behavioral health reimbursement.

Read the full article here:
https://www.stephanieallardconsulting.com/articles/equalizing-reimbursement-for-90837-and-90834-sends-the-wrong-message-to-behavioral-health-providers

#90837 #90834