Too Many UDTs
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...
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- Jul 7, 2021
SCS: Prior Medicare Authorization in HOPD
Effective July 1, 2021, CMS has added cervical fusion with disc removal (22551/22552) and implanted spinal neurostimulator electrodes...
- Jul 7, 2021
No Surprises Act: Interim Final Rule
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,...
- Jul 4, 2021
Fluoro with Pump Refills?
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...
- Jun 30, 2021
AMA Clarifies Coding of a Popliteal Fossa Block
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...
- Jun 15, 2021
Reporting for PRF Money Updated
1. Overview. On June 11, 2021, the Government released updated reporting instructions (the “Instructions”) for those groups that...
- Jun 9, 2021
AMA Clarifies the Amount of Data for E/M Coding
When coding office visits by medical decision making (“MDM”), one must meet 2 of 3 components: (1) the nature of the problem; (2) the...
- Apr 30, 2021
What if the Patient is Afraid of RF?
1. The Issue. The new Facet LCD states that you cannot do therapeutic facet blocks unless you document that the patient is not a...
- Apr 28, 2021
Append KX Modifier for Dx Facet Blocks
1. LCA vs LCD. You may not have seen the Medicare requirement to add the KX modifier to all diagnostic facet blocks because that...
- Apr 27, 2021
New Facet LCD Updates
PSYCHOLOGICAL REFERRAL OR NOT. There is new, helpful information from two of the Medicare medical directors on the issue of whether they...
- Apr 26, 2021
Medicare PowerPoint on New Facet Policy
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...
- Apr 23, 2021
EPIC: Denied Claims for No CRNA Electronic Signature
1. Medicare Denials. I have a large anesthesia group undergoing an EPIC implementation. My client advised me that the EPIC programmers...
- Apr 20, 2021
Facet "Gotcha"
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...
- Apr 19, 2021
U/S Billable for Arterial Line Placement
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...
- Apr 16, 2021
New Facet Policies Nationwide
New Medicare facet LCDs are taking effect around the country on April 25. There are material, onerous changes. All of the Medicare...
- Feb 2, 2021
2021 Back and Knee Brace Denials
1. Overview. If you are getting denials on your back braces and knee braces, it may be because you are in a certain zip-code and you...
- Jan 20, 2021
Landmark Case: HIPAA Fine Reversed
Reversal. Good news on the HIPAA front. A very damaging case has been reversed. On January 14, 2021, the federal 5th Circuit Court of...
- Dec 28, 2020
New Act: More Money; Surprise Medical Billing
Increased Conversion Factors. The Consolidated Appropriations Act, 2021 (the “Act”) passed by Congress and signed by President Trump...
- Dec 23, 2020
Proposed Rule to Amend HIPAA
On December 10, 2020, HHS released a 357-page Proposed Rule to amend HIPAA. Proposed rules typically become final about 6 months after...
- Dec 21, 2020
More Government Money Coming
1. More PRF Money. On December 16, 2020 HHS announced it would begin Phase III distributions of an additional $24 Billion in provider...
- Dec 3, 2020
CMS Releases 2021 Medicare Final Rule
The CMS Final Rule for the 2021 Medicare Physician Fee Schedule was released December 1 and contains over 2,100 pages of information. ...
- Nov 24, 2020
CMS Releases New Stark Final Rule
1. Effective Date. On November 20, 2020, CMS issued a Final Rule on Stark. There have been numerous “final” rules on Stark; this is...
- Nov 23, 2020
New OIG Kickback Final Rule
On November 20, 2020, the Government issued two significant Final Rules, one relating to the Anti-kickback statute (“AKS”), and the other...
- Oct 29, 2020
Imminent Ransomware Threat
I received the following email from one of my clients, and I am passing it along in case this threat comes to fruition. We have learned a...
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