According to recently clarified guidelines by Indiana Medicaid, all physician assistants must now enroll as Indiana Health Coverage Providers and can no longer be billed under a supervising physician’s NPI. This change, which brings billing for PAs into alignment with billing for other Mid-Level, or Non-Physician Providers, also reduces reimbursement for PA services to 75 percent of the Medicaid allowed amount. READ MORE
The claim some payers make that the ED is being overused for “non-urgent” conditions is being challenged by reports from the CDC released earlier this year which show that only 5.5 percent of all ED visits are considered non-urgent. READ MORE
The Medicare Payment Advisory Commission recently voted to recommend that payment rates for off-campus stand-alone EDs located within six miles of an on-campus hospital ED be cut by 30 percent. READ MORE
As of March 1, 2018, UnitedHealthcare began using their Optum Emergency Department Claim Analyzer tool to evaluate facility ED claims and then deny or reduce payment for services they deem to be incorrectly coded. READ MORE
Even though we’re almost two months into 2018, it’s not too late for emergency physicians to participate in the 2018 MIPS to avoid a negative 5 percent adjustment on Medicare Part B payments in 2020. READ MORE
Beginning January 1, 2018, Anthem Blue Cross and Blue Shield began enforcing a new policy in Indiana which denies payment for emergency department charges for what Anthem considers “non-emergency” conditions and requires patients to pay out of pocket. READ MORE
Managed Health Services is the latest payer to create payment policies aimed at keeping patients from making emergency department visits for “non-emergency” conditions. READ MORE
While Medicare fees generally will see a small increase in 2018, emergency physicians in Indiana will see a small decrease. READ MORE
Physicians taking advantage of new unbundled codes for billing moderate or conscious sedation are receiving denials from Medicare for one of them. That code, 99153, which is the add-on code for additional time spent administering conscious sedation by a provider who’s also performing the primary service, has been denied by Medicare when the service was performed in a facility setting. READ MORE
Back in July, Medicare Administrative Contractor WPS-GHA randomly selected 100 Indiana and Michigan claims which contained CPT code 99285 for prepayment review. Shockingly, of these 100 services, only three (3.06 percent) were allowed as billed, and the remaining 97 (96.94 percent) were denied. What can we learn from these results? READ MORE
