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:ICD-10 Guidelines: Sometimes You Have to Break the RulesNew Rules Issued for Modifiers 59, XE, XS, XP, and XUAuditing Postoperative Sinus DebridementsCMS Proposes Payment Changes to Endoscopic Sinus Codes

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 Related Posts:Telemedicine Offers Benefits to Providers

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:Anthem Investigator Charged with FraudHealthcare Job Growth Greatest in 2018Millennials and Their Healthcare AccessMichigan 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:Changing the Way Medicare Pays DoctorsAppeals Backlog Gone in 4 Years: MedicareMedicare Part D Prescription Drug Model to Change in 2020CMS Goes After Medicare Advantage OverpaymentsOIG 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…98point6 Wants to be Amazon Prime of Primary Care3 Issues in 2019 Virtual CareBundled Payments Reduce Care CostHow to Document E/M with Counseling and Coordinating 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:Will Computer-Assisted Coding Make Coders Obsolete?Coding News

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:CMS Proposes Add-on Codes for E/M Services3 Issues in 2019 Virtual CareAppeals Backlog Gone in 4 Years: MedicareCMS Goes After Medicare Advantage OverpaymentsPrevent Medicare Claims Denials in 2020AMA on Evaluation and Management Guidelines

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 Related Posts:Get More Involved with Your Local AAPC Chapter

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