If you are wondering what verbiage to use for your Disclosure Notice and your Notice and Consent forms required under the Surprise...

The 2022 Medicare Physician’s Fee Schedule Final Rule was released last week, containing over 2,000 pages. Introduction. Here are some...

1. New OIG Opinion. Today the OIG emailed me a formal Advisory Opinion (21-15) which I requested 2 ½ years ago regarding whether it is...

New Epidural LCDs Effective in December. Effective this December all Medicare carriers have adopted a new epidural LCD that rewrites the...

Make sure you are waiting to review the results of your presumptive UDTs before ordering the confirmations. Two months ago, a pain...

The OIG just released nationwide audit results of stimulator implants, wherein it found that 40% of the claims did not contain sufficient...

1. New Medicare Auditing Metrics. When it comes to the likelihood of your group being audited by Medicare for excessive urine drug...

1. New Interim Rule. On September 30, 2021, CMS released its 2nd Interim Final Rule (the “Rule”; which is 520 pages long) detailing how...

Many of you received Provider Relief Funds (“PRF”) which initially just showed up in your bank account without requesting it. ...

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...

Effective July 1, 2021, CMS has added cervical fusion with disc removal (22551/22552) and implanted spinal neurostimulator electrodes...

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,...

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...

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...

1. Overview. On June 11, 2021, the Government released updated reporting instructions (the “Instructions”) for those groups that...

When coding office visits by medical decision making (“MDM”), one must meet 2 of 3 components: (1) the nature of the problem; (2) the...

1. The Issue. The new Facet LCD states that you cannot do therapeutic facet blocks unless you document that the patient is not a...

1. LCA vs LCD. You may not have seen the Medicare requirement to add the KX modifier to all diagnostic facet blocks because that...

PSYCHOLOGICAL REFERRAL OR NOT. There is new, helpful information from two of the Medicare medical directors on the issue of whether they...

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...

1. Medicare Denials. I have a large anesthesia group undergoing an EPIC implementation. My client advised me that the EPIC programmers...

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...

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...

New Medicare facet LCDs are taking effect around the country on April 25. There are material, onerous changes. All of the Medicare...