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Mar 4, 2020
Billing QZ for AAs
There have been 4 carriers who have previously published articles or sent emails stating that anesthesiologist's assistants ("AA") can be...
Feb 5, 2020
Medicare Enrollment Revalidation
Approximately every five years, providers must revalidate their Medicare enrollment. The provider or group’s Medicare Administrative...
Jan 7, 2020
CMS Changes to DME Orders
1. Standard Written Order. Effective January 1, 2020, changes have been made by CMS to ordering DME and orthotics, such as back braces....
Dec 29, 2019
E/M Overhaul for 2021
1. Overview. Determining the level of 99201-99215 will be completely overhauled by both the AMA and CMS effective 1/1/2021 (not 2020). ...
Dec 29, 2019
What's New for Chronic Pain in 2020
This Article is designed to highlight the primary coding and billing changes affecting chronic pain in 2020. 1. CPT Code Changes. I...
Dec 29, 2019
What's New for Anesthesia in 2020
The following is a synopsis of the material billing, coding, and documentation changes affecting anesthesia in 2020. 1. Reimbursement. ...
Sep 6, 2019
Primer for Ordering Back Braces
Back braces have been targeted for the past 5 years by Medicare. We have defended several audits denying back braces for very technical...
Aug 4, 2019
New False Claims Act Case Involving UDT
On July 22, 2019, the U.S. DOJ intervened in a False Claims Act case against a Tennessee pain group and its owners, and filed a 104-page...
May 20, 2019
New Medicare Part D Opioid Policies for 2019
CMS has finalized new policies for Medicare Part D plans to follow beginning January 1, 2019. These changes are in response to the opioid...
Feb 6, 2019
Medicare Credentialing: Authorized Official vs Delegated Official
Chapter 15 of the Medicare Program Integrity Manual provides specific instructions as to who can sign initial Medicare credentialing...
Jan 31, 2019
New 855I Enrollment Form
Medicare has a new 855I Enrollment Application form. The 855I is for credentialing new physicians and NPPs (non-physician practitioners)...
Jan 29, 2019
New DOS Rules
On January 24, 2019, CMS released an update of its Date of Service (“DOS”) rules, i.e., when to bill services such as radiology, labs,...
Jan 19, 2019
How to Code an Erector Spinae Block
The AMA recently clarified in its December 2018 issue of the CPT Assistant whether an erector spinae block for post-op pain can be billed...
Jan 19, 2019
Does Modifier 50 Apply to TPIs?
The AMA recently clarified in its December 2018 issue of the CPT Assistant , whether a trigger point injection performed bilaterally can...
Jan 19, 2019
Injection of the Sciatic Notch
In the December 2018 issue of the CPT Assistant, the AMA issued instructions on how to bill for injection of steriod into the sciatic...
Dec 29, 2018
What's New for Pain Management in 2019
I. Overview. This article will outline changes affecting pain practices in 2019 relating to: (1) Medicare reimbursement for pro fees...
Dec 29, 2018
New Criminal Statute re Lab Payments
Applicability of Statute. Effective October 24, 2018, a new federal criminal statute went into effect directed at, among other things,...
Dec 29, 2018
What's New for Anesthesia in 2019
1. Changes in Medicare Reimbursement. There were slight increases in the Medicare conversion factor (“CF”) from 2018. The anesthesia CF...
Nov 4, 2018
CMS Changes to E/M Payment & Documentation
On November 1, 2018, CMS released the Final Rule for the 2019 Medicare Physicians Fee Schedule. The scope of this article is limited to...
Oct 24, 2018
"Incident to" Billing
Not all payers allow "incident to" billing. "Incident to" billing is a Medicare billing methodology which pays the practice 100%, even...
Jul 15, 2018
Medicare Proposes Revised E/M Payment & Documentation Rules
1. Proposed Rule Changes Payment for and Documentation of E/M Codes. Medicare is proposing to change the way it pays for E/M codes and...
Mar 1, 2018
Palmetto Takes Over Cahaba Providers
Effective 2/23/18, all Medicare providers previously under Cahaba's jurisdiction will now be under Palmetto's jurisdiction. When you log...
Feb 12, 2018
Anthem Restricts Use of Anesthesia for Cataract Surgery
On February 1, 2018, Anthem published a new coverage policy which restricts the use of monitored anesthesia care (“MAC”) and general...
Feb 12, 2018
AMA Modifies Coding Opinion for Genicular RF
In December 2015, the AMA issued an opinion indicating that the injection of the superior medial, lateral, and inferior branches of the...
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