V&A Articles | Lalawfirm

Feb 23

HIPAA Updates

On February 14, 2024, the Office of Civil Rights (“OCR”), which investigates HIPAA and issues fines and penalties, released a report to...

Feb 18

Recent Chronic Pain Audits

There have been several recent chronic pain audits our clients are undergoing. 1. Kyphoplasty and Vertebroplasty. Performant...

Feb 18

Denials of Post-op Pain Blocks

1. Post-op Pain Block Denials. United Healthcare (“UHC”) has started denying post-op pain blocks (“POP Blocks”) if there is no...

Jan 24

E&M Levels: Medicare Data

Many of you have periodically requested information as to the Medicare data on how your peers are billing 99202-99205 and 99211-99215 now...

Dec 23, 2023

Medicare Credentialing Changes

CMS has discontinued the 855R credentialing form. The 855R form has been used for over 25 years to reassign Medicare benefits to group...

Dec 6, 2023

Documenting Anesthesia Time

The following factors should be taken into account when documenting pre-OR time, in room time, and PACU time. 1. START TIME. a. ...

Nov 30, 2023

MEDICAL COMPLIANCE CENTER'S 2024 ANESTHESIA & CHRONIC PAIN WEBINARS

REGISTRATION IS NOW OPEN FOR MEDICAL COMPLIANCE CENTER'S 2024 ANESTHESIA & CHRONIC PAIN COMPLIANCE UPDATES JANUARY 11 & 12, 2024 Each of...

Nov 16, 2023

DHHS Enforcement Actions Involving Anesthesia and Chronic Pain

DHHS just released its Annual Report for the Health Care Fraud & Abuse Control Program, wherein it detailed the Government’s latest...

Nov 12, 2023

Billing Telehealth from Home

We know that Medicare is allowing, for 2024, the patient to be at home and receive a telehealth service that is billable to Medicare. ...

Nov 11, 2023

Gastric U/S is Not Bundled for Anesthesia

We recently submitted a request for an official opinion to the AMA regarding whether an abdominal U/S is bundled into the anesthesia base...

Nov 9, 2023

Telehealth Incident to Billing

1. Virtual Direct Supervision. The 2024 Medicare Physician’s Fee Schedule Final Rule confirms that for 2024, Medicare will continue to...

Nov 7, 2023

Changes to Medicare Telehealth Modifier and Place of Service Codes

Medicare is changing how to report place of service codes and modifiers for telehealth services in 2024. For 2023, you reported the...

Nov 6, 2023

Telephone Visits for 2024

The Medicare Physician's Fee Schedule Final Rule was released November 2, 2023, in which CMS confirmed that telephone visits remain on...

Nov 5, 2023

New Medicare Conversion Factors for 2024

The 2024 Medicare Physicians Fee Schedule Final Rule (the "Final Rule") was released November 2, 2023. The Final Rule states that the...

Nov 5, 2023

Should You Have a Different Fee Schedule for Medicare?

There is an urban myth that you can only have one fee schedule. Not true, although you should address the reason for different fee...

Oct 6, 2023

Rx Drugs Not Enough for 99214

Most pain physicians try to achieve billing 99214 (moderate medical decision making) by relying on the fact that they have prescribed...

Sep 3, 2023

UDT Cannot be Billed as Incident to

In a recent TPE (Targeted Probe and Educate) audit that we are defending, Palmetto GBA (one of the Medicare carriers) is taking the...

Sep 3, 2023

Unnecessary Moderate Sedation Settlement

1. Settlement. On August 24, 2023, the U.S. DOJ released a press release in which it confirmed a $6.5mm settlement with an...

Jul 18, 2023

Medicare Temporary Bundling of UDT Codes

1. Medicare Bundling of Screens and Definitive Tests. Effective July 1, 2023, CMS implemented NCCI edits between Column One codes...

May 23, 2023

New DEA Rules on Telehealth Rx of Narcotics

On May 10, 2023, the DEA issued a Temporary Rule regarding using telehealth to issue electronic prescriptions of opioids after the PHE...

May 3, 2023

Update on Telephone Only Calls After the PHE

CMS has published an update on what PHE flexibilities will be extended after the PHE. I previously reported that telephone only calls...

Apr 18, 2023

End of the PHE

1. End of the PHE. DHHS is terminating the PHE on May 11, 2023. Many of the PHE waivers will end on May 11; however, some will continue...

Mar 28, 2023

New SIJ Injection LCDs

Five of the seven Medicare Carriers around the country have adopted a multijurisdictional new LCD for SI Joint Injections (“SIJIs”). The...

Mar 15, 2023

STIMWAVE Former CEO Indicted

Many of you have inquired about using STIMWAVE (“SW”) stimulator products and whether Medicare would pay for them. The DOJ just issued a...