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...

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...

Reversal. Good news on the HIPAA front. A very damaging case has been reversed. On January 14, 2021, the federal 5th Circuit Court of...

Increased Conversion Factors. The Consolidated Appropriations Act, 2021 (the “Act”) passed by Congress and signed by President Trump...

On December 10, 2020, HHS released a 357-page Proposed Rule to amend HIPAA. Proposed rules typically become final about 6 months after...

1. More PRF Money. On December 16, 2020 HHS announced it would begin Phase III distributions of an additional $24 Billion in provider...

The CMS Final Rule for the 2021 Medicare Physician Fee Schedule was released December 1 and contains over 2,100 pages of information. ...

1. Effective Date. On November 20, 2020, CMS issued a Final Rule on Stark. There have been numerous “final” rules on Stark; this is...

On November 20, 2020, the Government issued two significant Final Rules, one relating to the Anti-kickback statute (“AKS”), and the other...

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...

The OIG has released an update to its annual Work Plan particularly geared towards COVID-19 issues. The Work Plan is the OIG’s list of...

1. The "5 Rule." Today, the OIG released the results of a nationwide audit it has conducted on providers overbilling the 5 facet...

As you may remember, in addition to the Provider Relief Fund, CMS offered a loan program where you could accept a loan against future...

Just when you thought COVID had everyone locked up in their offices not doing anything, the DOJ just announced the largest fraud and...

Today HHS announced another $20 billion in provider relief funds in what is being called “Phase 3” provider relief funding. You can...