Special Rules Apply to Endoscopic Sinus Surgeries

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

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OIG Expects to Recover $5.9B in Healthcare Fraud

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

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Prevent Medicare Claims Denials in 2020

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…

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Is Direct Primary Care the Answer?

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…

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OIG Uncovers Medicare Overpayments for Chronic Care Management Services

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

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How Many Units of 95165 Can You Bill, Really?

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

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MDM – New Problem to Examiner or Patient?

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

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