On December 21, President Biden signed into law a Continuing Resolution (“CR”) that provided enough money to allow the government to...

Although it isn't likely that anesthesia or pain management practices will receive a request for PHI relating to reproductive healthcare,...

$1.19mm Fine . A pain practice in Florida just paid a $1.19 million fine for a self-reported HIPAA violation. The pain practice...

I have received several questions about the recent extension of telehealth flexibilities as it relates to prescribing controlled...

In my last article, I summarized the 2025 Medicare Physician’s Fee Schedule Final Rule, and its provisions on telehealth which allowed,...

The 2025 CPT Code has adopted 6 new codes for plane blocks.  There are codes for unilateral, bilateral, single shot, and continuous...

On November 1, 2024, Medicare posted its 2025 Medicare Physician's Fee Schedule Final Rule, consisting of over 3,000 pages. Below is a...

1.     Epidural Denials .   In a recent Medicare TPE audit (Targeted Probe & Educate) one of my clients had all 40 ESI claims denied...

Listing the Patient’s Medications.   Many physicians think that if they document in their progress notes a list of the medications the...

1.     CRNA Reimbursement Reduced .  Anthem BCBS is reducing CRNA reimbursement to 85% effective November 1, 2024, for most of the states...

On April 23, 2024, the U.S. Federal Trade Commission ("FTC") adopted a rule (the “Rule”) to ban non-compete agreements with workers....

Medicare just updated its MLN Fact Sheet regarding billing QMBs (i.e., “Qualified Medicare Beneficiaries” who are dually eligible for...

1.     TPE Audit of Blocks.  One of the Medicare carriers, Noridian (MAC for all states in the western US), is conducting a TPE (Targeted...

Issue.  There is no national CMS rule as to whether Medicare will reimburse anesthesiologists the same for supervising or medically...

1.     Noridian Denials.  In a recent audit of one of our clients the Carrier Medical Director for Noridian (Medicare carrier for most of...

1.     ALJ Opinion.  On May 30, 2024, an Administrative Law Judge (“ALJ”) rendered an opinion in a case in which I was involved relating...

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...

To combat states from using PHI to investigate patients and physicians for legal abortions, the OCR released a Final Rule which...

1.     Procedure Title vs Procedure Detail.  In a recent audit of one of our clients, Medicaid auditors disallowed epidural and facet...

Five of the seven Medicare Carriers have just adopted a new multi-jurisdictional LCD for Trigger Point Injections (“TPIs”).  The new LCDs...

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...

One of our clients just forwarded a publication from Aetna dated April 8, 2024, providing a required 90-day notice that effective July...

For pain practices still using and coding for the steroid Depo-Medrol, CMS has changed the coding effective April 1, 2024. CMS has...

1.     Overview.   The OCR is clarifying the obligations regarding online tracking technologies used in your websites and mobile apps....