Incident-to Billing May Be Eliminated
Incident-to billing for advanced practice providers (nurse practitioners, physician assistants, clinical nurse practitioners, nurse midwives, etc.) has been available to limited license practitioners s… For more, read here: AAPC...
2 Tips for Billing a Physician Assistant as Assistant Surgeon
A physician assistant (PA) serves as an assistant surgeon only to suture and close an incision. There is no documentation that the PA performed any other function to assist the primary surgeon during the surgery performed on the Medicare patient, suc… For more,...
CMS Goes After Medicare Advantage Overpayments
The Centers for Medicare & Medicaid Services (CMS) knows that a significant amount of money is being overpaid to insurance companies in the Medicare Advantage program, but they have yet to recover these overpayments. That’s about to change. CMS sa… For...
CMS Proposes Payment Changes to Endoscopic Sinus Codes
The Centers for Medicare & Medicaid Services (CMS) is proposing major payment changes to sinus endoscopy services. The 2020 Physician Fee Schedule (PFS) proposed rule includes the following excerpt: We are proposing to apply the special rule for m… For...
Anthem Changes Timely-Filing Deadlines
Anthem has sent out a notice to all providers who have signed non-Medicare or Medicare Advantage contracts with them, stating: “Effective for all commercial and Medicare Advantage Professional Claims submitted to the plan on or after Oct. 1, … For more, read...
ICD-10 Guidelines: Sometimes You Have to Break the Rules
Rik Salomon, CPC, CRC, CEDC, CEMA, CMCS, and I recently got into a rather spirited debate with a group of Certified Professional Coders (CPCs®) on coding guidelines and how they govern our medical coding. CPT® and ICD-10 guidelines are the primary det… For more,...
Reporting Bilateral Services: Conflicting Information Causes Confusion
Payer-specific rules — especially rules that vary for every claim — not only make collecting revenue difficult, but also add to the cost of collection of monies earned by the physicians. A blog clarifies Novitas’ instructions for reporting modifier … For more,...
Michigan Surgeon Accused of $60M Billing Fraud
Bay City, Michigan surgeon Vasso Godiali, MD, was indicted on July 10, 2019, for allegedly orchestrating a $60 million healthcare fraud scheme. He is also charged with money laundering for financial transactions involving almost $50 million in proceed… For more,...
Getting Inspire Therapy for Sleep Apnea Covered
Obstructive sleep apnea causes those who suffer from it to sleep poorly and always feel tired. Obstructive sleep apnea is also indicative for heart Inspire® therapy is a promising alternative to traditional treatment options for sleep apnea, but getting it covered...
Billing 95165 Is Nothing to Sneeze At
The professional service of preparation and provision of antigens for allergen immunotherapy — reported using CPT® 95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple … For more,...