Primer for Ordering Back Braces
Back braces have been targeted for the past 5 years by Medicare. We have defended several audits denying back braces for very technical...
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- Aug 4, 2019
New False Claims Act Case Involving UDT
On July 22, 2019, the U.S. DOJ intervened in a False Claims Act case against a Tennessee pain group and its owners, and filed a 104-page...
- May 20, 2019
New Medicare Part D Opioid Policies for 2019
CMS has finalized new policies for Medicare Part D plans to follow beginning January 1, 2019. These changes are in response to the opioid...
- Feb 6, 2019
Medicare Credentialing: Authorized Official vs Delegated Official
Chapter 15 of the Medicare Program Integrity Manual provides specific instructions as to who can sign initial Medicare credentialing...
- Jan 31, 2019
New 855I Enrollment Form
Medicare has a new 855I Enrollment Application form. The 855I is for credentialing new physicians and NPPs (non-physician practitioners)...
- Jan 29, 2019
New DOS Rules
On January 24, 2019, CMS released an update of its Date of Service (“DOS”) rules, i.e., when to bill services such as radiology, labs,...
- Jan 19, 2019
How to Code an Erector Spinae Block
The AMA recently clarified in its December 2018 issue of the CPT Assistant whether an erector spinae block for post-op pain can be billed...
- Jan 19, 2019
Does Modifier 50 Apply to TPIs?
The AMA recently clarified in its December 2018 issue of the CPT Assistant , whether a trigger point injection performed bilaterally can...
- Jan 19, 2019
Injection of the Sciatic Notch
In the December 2018 issue of the CPT Assistant, the AMA issued instructions on how to bill for injection of steriod into the sciatic...
- Dec 29, 2018
What's New for Pain Management in 2019
I. Overview. This article will outline changes affecting pain practices in 2019 relating to: (1) Medicare reimbursement for pro fees...
- Dec 29, 2018
New Criminal Statute re Lab Payments
Applicability of Statute. Effective October 24, 2018, a new federal criminal statute went into effect directed at, among other things,...
- Dec 29, 2018
What's New for Anesthesia in 2019
1. Changes in Medicare Reimbursement. There were slight increases in the Medicare conversion factor (“CF”) from 2018. The anesthesia CF...
- Nov 4, 2018
CMS Changes to E/M Payment & Documentation
On November 1, 2018, CMS released the Final Rule for the 2019 Medicare Physicians Fee Schedule. The scope of this article is limited to...
- Oct 24, 2018
"Incident to" Billing
Not all payers allow "incident to" billing. "Incident to" billing is a Medicare billing methodology which pays the practice 100%, even...
- Jul 15, 2018
Medicare Proposes Revised E/M Payment & Documentation Rules
1. Proposed Rule Changes Payment for and Documentation of E/M Codes. Medicare is proposing to change the way it pays for E/M codes and...
- Mar 1, 2018
Palmetto Takes Over Cahaba Providers
Effective 2/23/18, all Medicare providers previously under Cahaba's jurisdiction will now be under Palmetto's jurisdiction. When you log...
- Feb 12, 2018
Anthem Restricts Use of Anesthesia for Cataract Surgery
On February 1, 2018, Anthem published a new coverage policy which restricts the use of monitored anesthesia care (“MAC”) and general...
- Feb 12, 2018
AMA Modifies Coding Opinion for Genicular RF
In December 2015, the AMA issued an opinion indicating that the injection of the superior medial, lateral, and inferior branches of the...
- Feb 12, 2018
Medicare Follow-up Regarding Genicular Blocks
In the article we wrote this morning about the AMA's changed position on genicular nerve RFs, I need to distinguish between Medicare and...
- Jan 28, 2018
Back and Knee Braces Hit the OIG's Work Plan
This month the OIG just updated its "Work Plan" for 2018 by adding "Off-the-Shelf Orthotic Devices" to the Work Plan. The OIG will...
- Jan 16, 2018
2018 Changes to ASA Crosswalk and RVG
1. Changes to ASA Crosswalk. There were a number of changes in the 2018 version of the ASA's Crosswalk. Many were not significant, but...
- Jan 16, 2018
2018 Base Unit Values- ASA RVG vs. CMS
The list below contains anesthesia codes where the base unit values are different in the ASA RVG when compared to CMS for 2018. All...
- Dec 17, 2017
Recap of 2017 HIPAA Cases and Guidance
In 2017, the OCR assessed fines and exacted settlements in 10 cases that it reported on its website, and also issued new guidance on 5...
- Dec 11, 2017
What's New in Chronic Pain for 2018
UDT Confirmation Reimbursement. Medicare reimbursement for confirmation codes G0480-83 will be reduced 10% per year for the next 3...
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