top of page
Dec 6
Disclosure of Reproductive Health Care PHI
Although it isn't likely that anesthesia or pain management practices will receive a request for PHI relating to reproductive healthcare,...
Dec 5
HIPAA Fine & 4 Recommended Solutions
$1.19mm Fine . A pain practice in Florida just paid a $1.19 million fine for a self-reported HIPAA violation. The pain practice...
Dec 3
Telehealth Extension for Prescribing Drugs
I have received several questions about the recent extension of telehealth flexibilities as it relates to prescribing controlled...
Nov 12
Clarification on Home Telehealth
In my last article, I summarized the 2025 Medicare Physician’s Fee Schedule Final Rule, and its provisions on telehealth which allowed,...
Nov 8
How to Code Plane Blocks
The 2025 CPT Code has adopted 6 new codes for plane blocks. There are codes for unilateral, bilateral, single shot, and continuous...
Nov 6
2025 Medicare Final Rule
On November 1, 2024, Medicare posted its 2025 Medicare Physician's Fee Schedule Final Rule, consisting of over 3,000 pages. Below is a...
Aug 19
Epidural Denials Due to Steroids
1. Epidural Denials . In a recent Medicare TPE audit (Targeted Probe & Educate) one of my clients had all 40 ESI claims denied...
Aug 13
Rx Drug Management for 99214
Listing the Patient’s Medications. Many physicians think that if they document in their progress notes a list of the medications the...
Aug 9
Anthem BCBS Reduces CRNA Reimbursement
1. CRNA Reimbursement Reduced . Anthem BCBS is reducing CRNA reimbursement to 85% effective November 1, 2024, for most of the states...
Aug 7
FTC Bans Non-Compete Agreements
On April 23, 2024, the U.S. Federal Trade Commission ("FTC") adopted a rule (the “Rule”) to ban non-compete agreements with workers....
Aug 1
New Medicare Rules on Billing QMBs
Medicare just updated its MLN Fact Sheet regarding billing QMBs (i.e., “Qualified Medicare Beneficiaries” who are dually eligible for...
Jun 29
New Onerous Requirements for POP Blocks
1. TPE Audit of Blocks. One of the Medicare carriers, Noridian (MAC for all states in the western US), is conducting a TPE (Targeted...
Jun 12
Are Student AAs the Same as SRNAs?
Issue. There is no national CMS rule as to whether Medicare will reimburse anesthesiologists the same for supervising or medically...
Jun 11
Noridian Denies Preoperatively Placed Brachial Plexus Blocks
1. Noridian Denials. In a recent audit of one of our clients the Carrier Medical Director for Noridian (Medicare carrier for most of...
Jun 7
ALJ Opinion on PNS and Psych Codes
1. ALJ Opinion. On May 30, 2024, an Administrative Law Judge (“ALJ”) rendered an opinion in a case in which I was involved relating...
Jun 1
Update on Change Healthcare Breach
Some of you have been affected by the Change Healthcare breach, and I have previously advised you that the OCR views this as a breach...
May 4
HIPAA Amendments re Reproductive Health Care
To combat states from using PHI to investigate patients and physicians for legal abortions, the OCR released a Final Rule which...
Apr 23
Audits of Levels and Sides of Injections
1. Procedure Title vs Procedure Detail. In a recent audit of one of our clients, Medicaid auditors disallowed epidural and facet...
Apr 23
New Trigger Point LCDs
Five of the seven Medicare Carriers have just adopted a new multi-jurisdictional LCD for Trigger Point Injections (“TPIs”). The new LCDs...
Apr 19
Incident to: Medication Changes
Query. If a midlevel practitioner (NP/PA) adjusts medication on a follow-up visit, can that visit be billed incident to, in the name of...
Apr 11
Aetna Stops Paying for Physical Status
One of our clients just forwarded a publication from Aetna dated April 8, 2024, providing a required 90-day notice that effective July...
Apr 8
Depo-Medrol Coding Changes
For pain practices still using and coding for the steroid Depo-Medrol, CMS has changed the coding effective April 1, 2024. CMS has...
Mar 21
OCR Requires BAAs with Tracking Vendors
1. Overview. The OCR is clarifying the obligations regarding online tracking technologies used in your websites and mobile apps....
Mar 13
Billing New Medicare Add-on Code G2211
1. Overview. I have received many questions about the new Medicare code G2211 which is an add-on code that can be billed to Medicare...
bottom of page