Coding News – CRN Healthcare Solutions

2021 Physician Fee Schedule Final Rule – Prolonged Services

by BJC2017 | Dec 3, 2020

by Barbara J Cobuzzi The 2021 Physician Fee Schedule Final Rule was published by CMS on Tuesday December 1, 2020. (https://www.cms.gov/files/document/12120-pfs-final-rule.pdf) There were not many surprises since we had the Proposed Rule to review during the late...

Special Rules Apply to Endoscopic Sinus Surgeries

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jan 9, 2020

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,...

Helping Substance Abusers Via Telemedicine

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Dec 26, 2019

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,...

OIG Expects to Recover $5.9B in Healthcare Fraud

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Dec 17, 2019

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,...

Prevent Medicare Claims Denials in 2020

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Dec 10, 2019

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,...

Is Direct Primary Care the Answer?

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Dec 5, 2019

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,...

OIG to Audit Risk Adjustment Coding

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Nov 27, 2019

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,...

Ascension Enters Contract with Google to Share PHI

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Nov 18, 2019

If you are a patient of Ascension in the St. Louis, Mo., area, Google has your healthcare protected health information (PHI). Patients and doctors of the second largest Catholic health system in the United States have not been notified that their data… For more,...

OIG Uncovers Medicare Overpayments for Chronic Care Management Services

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Nov 14, 2019

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,...

Pharmaceutical Compounding Chapter Revisions on Hold

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Oct 30, 2019

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,...

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OIG Expects to Recover $5.9B in Healthcare Fraud

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Dec 17, 2019 | AAPC, Billing, Coding, Compliance, Legal, OIG

Prevent Medicare Claims Denials in 2020

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Dec 10, 2019 | AAPC, Billing, Medicare

OIG to Audit Risk Adjustment Coding

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Nov 27, 2019 | AAPC, Coding, OIG, Risk Adjustment

Ascension Enters Contract with Google to Share PHI

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Nov 18, 2019 | Coding, Compliance, PHI, Technology

Pharmaceutical Compounding Chapter Revisions on Hold

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Oct 30, 2019 | AAPC, Compliance, Legal, Pharmacy

MDM – New Problem to Examiner or Patient?

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Sep 26, 2019 | AAPC, Billing, Coding, Evaluation & Management, MDM, Medicare

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,...

CMS Proposes Payment Changes to Endoscopic Sinus Codes

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Aug 12, 2019 | Billing, CMS, Coding, Guidelines, Medicare, Otolaryngology

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 more,...

Getting Inspire Therapy for Sleep Apnea Covered

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jul 17, 2019 | Billing, Coding, Otolaryngology

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

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jul 11, 2019 | Coding, Otolaryngology

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,...

You’ll Need This to Get Balloon Dilation of the Eustachian Tube Paid

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jun 7, 2019 | Billing, Coding, Otolaryngology

Clinical Consensus Statement: Balloon Dilation of the Eustachian Tube (BDET), published by the American Academy of Otolaryngology ̶ Head and Neck Surgery, June 4, is important because BDET is newer technology and may be rejected for payment by third… For more,...

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