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Oct 31, 2021
New Nationwide Epidural LCDs
New Epidural LCDs Effective in December. Effective this December all Medicare carriers have adopted a new epidural LCD that rewrites the...
Oct 25, 2021
$16mm UDT Settlement
Make sure you are waiting to review the results of your presumptive UDTs before ordering the confirmations. Two months ago, a pain...
Oct 7, 2021
OIG Targets SCS
The OIG just released nationwide audit results of stimulator implants, wherein it found that 40% of the claims did not contain sufficient...
Oct 5, 2021
How to Know if Medicare Will Audit You for UDT
1. New Medicare Auditing Metrics. When it comes to the likelihood of your group being audited by Medicare for excessive urine drug...
Oct 4, 2021
No Surprises Act: 2nd Interim Rule
1. New Interim Rule. On September 30, 2021, CMS released its 2nd Interim Final Rule (the “Rule”; which is 520 pages long) detailing how...
Sep 12, 2021
PRF Reporting
Many of you received Provider Relief Funds (“PRF”) which initially just showed up in your bank account without requesting it. ...
Jul 8, 2021
Too Many UDTs
1. FCA Settlement. On June 25, 2021, the U.S. Department of Justice (“DOJ”) issued a press release regarding a $1,002,481 settlement it...
Jul 7, 2021
SCS: Prior Medicare Authorization in HOPD
Effective July 1, 2021, CMS has added cervical fusion with disc removal (22551/22552) and implanted spinal neurostimulator electrodes...
Jul 7, 2021
No Surprises Act: Interim Final Rule
On July 1, 2021, HHS released the Interim Final Rule regarding the No Surprises Act (the “Act”) which was signed into law on December 27,...
Jul 4, 2021
Fluoro with Pump Refills?
1. Billing Fluoro with Pump Refill. In the June 2021 issue of the AMA’s CPT Assistant, the AMA stated that it would be appropriate to...
Jun 30, 2021
AMA Clarifies Coding of a Popliteal Fossa Block
For many years our clients have debated on whether to bill a popliteal fossa block as a sciatic nerve block (64445) or as a peripheral...
Jun 15, 2021
Reporting for PRF Money Updated
1. Overview. On June 11, 2021, the Government released updated reporting instructions (the “Instructions”) for those groups that...
Jun 9, 2021
AMA Clarifies the Amount of Data for E/M Coding
When coding office visits by medical decision making (“MDM”), one must meet 2 of 3 components: (1) the nature of the problem; (2) the...
Apr 30, 2021
What if the Patient is Afraid of RF?
1. The Issue. The new Facet LCD states that you cannot do therapeutic facet blocks unless you document that the patient is not a...
Apr 28, 2021
Append KX Modifier for Dx Facet Blocks
1. LCA vs LCD. You may not have seen the Medicare requirement to add the KX modifier to all diagnostic facet blocks because that...
Apr 27, 2021
New Facet LCD Updates
PSYCHOLOGICAL REFERRAL OR NOT. There is new, helpful information from two of the Medicare medical directors on the issue of whether they...
Apr 26, 2021
Medicare PowerPoint on New Facet Policy
CGS Medicare (KY/OH) has just created a PowerPoint for the new Facet LCD which is in effect today. Since the Facet LCD has been adopted...
Apr 23, 2021
EPIC: Denied Claims for No CRNA Electronic Signature
1. Medicare Denials. I have a large anesthesia group undergoing an EPIC implementation. My client advised me that the EPIC programmers...
Apr 20, 2021
Facet "Gotcha"
One thing I forgot to mention in my article last week regarding the new facet LCDs that take effect on April 25 is that there is a...
Apr 19, 2021
U/S Billable for Arterial Line Placement
1. U/S for Arterial Line Placements. I have received a formal opinion from the AMA that U/S for placement of arterial lines is...
Apr 16, 2021
New Facet Policies Nationwide
New Medicare facet LCDs are taking effect around the country on April 25. There are material, onerous changes. All of the Medicare...
Feb 2, 2021
2021 Back and Knee Brace Denials
1. Overview. If you are getting denials on your back braces and knee braces, it may be because you are in a certain zip-code and you...
Jan 20, 2021
Landmark Case: HIPAA Fine Reversed
Reversal. Good news on the HIPAA front. A very damaging case has been reversed. On January 14, 2021, the federal 5th Circuit Court of...
Dec 28, 2020
New Act: More Money; Surprise Medical Billing
Increased Conversion Factors. The Consolidated Appropriations Act, 2021 (the “Act”) passed by Congress and signed by President Trump...
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