Special Rules Apply to Endoscopic Sinus Surgeries

Special Rules Apply to Endoscopic Sinus Surgeries

January 9, 2020December 4, 2020Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

The multiple surgery calculation for nasal endoscopy codes is changed when multiple nasal endoscopies are performed in the same session on the same day. For Calendar Year 2020, instead of paying the multiple surgeries at 50 percent, surgeons will be … For more, read here: AAPC Blog Related Posts:CMS Proposes Payment Changes to Endoscopic Sinus CodesICD-10 Guidelines: Sometimes You Have to Break the Rules

Helping Substance Abusers Via Telemedicine

December 26, 2019December 4, 2020Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

The U.S. Drug Enforcement Administration (DEA) missed its deadline for creating regulations for a special registration process for prescribing controlled substances via telemedicine. What Is the Ryan Haight Online Pharmacy Consumer Protection Act? T… For more, read here: AAPC Blog

OIG Expects to Recover $5.9B in Healthcare Fraud

December 17, 2019December 4, 2020Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

The Office of Inspector General (OIG) expects a banner year in recoveries stemming from fraud investigations and audits. According to the OIG semiannual report, released Dec. 2, the U.S. Department of Health and Human services (HHS) stands to recoup a… For more, read here: AAPC Blog Related Posts:Michigan Surgeon Accused of $60M Billing Fraud

Prevent Medicare Claims Denials in 2020

December 10, 2019December 4, 2020Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Medicare has been issuing beneficiaries new member cards with Medicare Beneficiary Identifiers (MBI) in place of Social Security Numbers (SSNs) for more than two years. 2019 was a phase-in period when Medicare would accept either a beneficiary’s Socia… For more, read here: AAPC Blog Related Posts:CMS Goes After Medicare Advantage OverpaymentsNew Patient E/M Denials: Mystery SolvedCheck Your FESS Claims for Improper Payment AdjustmentsNew Medicare Cards Initiate Phishing ScamMedicare Telehealth Coding as of April 30OIG Uncovers Medicare Overpayments for Chronic Care…

Is Direct Primary Care the Answer?

December 5, 2019December 4, 2020Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Direct primary care (DPC) is one of the newer forms of plans offered by primary care providers to their patient populations. Some see DPC as an alternative to traditional third-party payment for care and other more recent models such as concierge med… For more, read here: AAPC Blog Related Posts:OIG Uncovers Medicare Overpayments for Chronic Care…

OIG to Audit Risk Adjustment Coding

November 27, 2019December 4, 2020Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Consistent with previous reporting, the Office of Inspector General (OIG) has added to its 2020 Work Plan a targeted audit of Medicare Advantage (MA) programs for risk adjustment diagnosis codes. This is not the first time federal agency has targeted … For more, read here: AAPC Blog Related Posts:Medicare Telehealth Coding as of April 30

OIG Uncovers Medicare Overpayments for Chronic Care Management Services

November 14, 2019December 4, 2020Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Chronic care management (CCM) services are services that do not involve face-to-face patient/provider contact. The Centers for Medicare & Medicaid Services (CMS) implemented Medicare coverage for CCM in Jan. 1, 2015. There are very specific guid… For more, read here: AAPC Blog Related Posts:Is Direct Primary Care the Answer?Medicare Telehealth Coding as of April 30Reporting Bilateral Services: Conflicting Information Causes…Prevent Medicare Claims Denials in 20202021 Physician Fee Schedule Final Rule – Prolonged ServicesNew Medicare Cards Initiate Phishing Scam

Pharmaceutical Compounding Chapter Revisions on Hold

October 30, 2019December 4, 2020Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

But for how long, nobody knows. allergy, otolaryngology and primary care practices can breathe a sigh of relief, as the new Compounding Pharmacy USP standards set to go into effect Dec. 1, 2019, have been postponed as a result of appeals. The revision… For more, read here: AAPC Blog

How Many Units of 95165 Can You Bill, Really?

September 30, 2019December 4, 2020Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Three credible sources give three different answers, and only one is right. The definition for billing units of allergy serum preparation for patients was recently challenged by a colleague of mine who works in the allergy space. Are there limitations… For more, read here: AAPC Blog Related Posts:Billing 95165 Is Nothing to Sneeze At

MDM – New Problem to Examiner or Patient?

September 26, 2019December 4, 2020Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

When calculating an evaluation and management (E/M) level or auditing an E/M service, every Medicare Administrative Contractor (MAC) has always had the points assigned for a new problem under the Number of Diagnoses or Treatment Options based on a new… For more, read here: AAPC Blog Related Posts:New Patient E/M Denials: Mystery Solved