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....

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...

On February 14, 2024, the Office of Civil Rights (“OCR”), which investigates HIPAA and issues fines and penalties, released a report to...

There have been several recent chronic pain audits our clients are undergoing. 1.     Kyphoplasty and Vertebroplasty.  Performant...

1.     Post-op Pain Block Denials.  United Healthcare (“UHC”) has started denying post-op pain blocks (“POP Blocks”) if there is no...

Many of you have periodically requested information as to the Medicare data on how your peers are billing 99202-99205 and 99211-99215 now...

CMS has discontinued the 855R credentialing form. The 855R form has been used for over 25 years to reassign Medicare benefits to group...

The following factors should be taken into account when documenting pre-OR time, in room time, and PACU time. 1. START TIME. a. ...

REGISTRATION IS NOW OPEN FOR MEDICAL COMPLIANCE CENTER'S 2024 ANESTHESIA & CHRONIC PAIN COMPLIANCE UPDATES JANUARY 11 & 12, 2024 Each of...

DHHS just released its Annual Report for the Health Care Fraud & Abuse Control Program, wherein it detailed the Government’s latest...

We know that Medicare is allowing, for 2024, the patient to be at home and receive a telehealth service that is billable to Medicare. ...

We recently submitted a request for an official opinion to the AMA regarding whether an abdominal U/S is bundled into the anesthesia base...

1. Virtual Direct Supervision. The 2024 Medicare Physician’s Fee Schedule Final Rule confirms that for 2024, Medicare will continue to...