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,...
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 more,...
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...
98point6 Wants to be Amazon Prime of Primary Care
A Seattle company looks to make primary care as easy as buying something off of Amazon.com. 98point6 is a Seattle start-up brain child of Rob Schwietzer who scaled Amazon Prime from thousands to millions and CEO Robbie Cape from Microsoft. 98point6 … For more,...
3 Issues in 2019 Virtual Care
Mandy Roth of Healthcare Leaders asked readers what they expected in the immediate future (2019) in virtual care, and if any trends can be predicted. As a result, three key issues stood out: Growth in virtual care will be spurred on by changes in reim… For more,...
Cybersecurity Guidance Issued by HHS
The Department of Health and Human Services (HHS) have issued new guidance for healthcare organizations to manage cyberattacks. This is the end result of the 2015 Cybersecurity Act to align the healthcare security practices. Cybersecurity Guidance … For more,...
Telehealth in Your Practice
Direct to Consumer/Patient When thinking about implementing telehealth in your practice, determine which platform will work best for your providers and patients. The market has consolidated into two major platforms, American Well and Teledoc… For more, read...
MD Anderson Pays $4.3 Million HIPAA Fine
In a time when many scoff at the potential of being levied steep penalties for violation of HIPAA rules, a judge just upheld a fine that the Department of Health and Human Services (HHS) issued in 2017 for Texas-based MD Anderson’s use of unencrypted … For more,...
New Jersey’s New Law Aimed Eliminates “Surprise” Medical Bills
The New Jersey (NJ) governor signed a new law designed to curb the impact of costly “surprise” medical bills when a patient sees a non-participating provider during an admission. The bill is quite complex but tries to balance the needs of patients, … For more,...
Anthem Investigator Charged with Fraud
A former fraud investigator for Anthem, Inc. is one of five people indicted on federal healthcare fraud charges. Those indicted participated in a multi-year scheme to commit fraud against at least eight health insurance companies. The fraud investigat… For more,...
Audiology Technician Billing
Medicare stipulates precise requirements for billing audiology technicians’ services. As outlined in the Centers for Medicare & Medicaid Services’ (CMS) Transmittal 84 in February 2008, these requirements are distinct from those governing audiolog… For...
Coding 3 or 4 Sinuses Using FESS Codes
A lot of people have been asking questions about how to code FESS surgeries with the new combination codes when three or four sinuses are operated on. Sinus and FESS We have been expecting an AMA CPT® Assistant article with guidance this year, but no … For more,...
Advocacy to Change 31241’s Pay to Outpatient
Advocates are seeking to convince the Centers for Medicare & Medicaid Services (CMS) to pay for outpatient care of patients receiving 31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery. The new code for 2018 was assigned… For...