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...
top of page
- 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...
- 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. ...
bottom of page