A recent report by the Department of Health and Human Services Office of Inspector General shines a light on significant billing issues for neurostimulator implantation surgeries. READ MORE
When you receive an overpayment demand letter from Medicare and disagree with the decision, there are two options for how to respond. You can submit either a rebuttal or an appeal. Your rebuttal and appeal rights will be clearly listed on the demand letter. READ MORE
For the fourth performance year in a row, the Centers for Medicare and Medicaid Services is making adjustments to the MIPS program as a result of the COVID-19 public health emergency. READ MORE
New Medicare local coverage determinations may hinder the ability to be paid for anesthesia services during Epidural Steroid Injections for pain management. The LCDs for several Medicare Administrative Contractors went into effect in late 2021, and others are being rolled out in 2022.
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While bringing on new physicians or other clinicians is an important part of building your medical practice, enrolling them with commercial and government payers can be time consuming…and costly. The tedious process leaves plenty of room for error and delay, both of which can mean missed opportunity for payment. As you work through enrolling providers, here are a few tips to ensure a timely and successful process. READ MORE
A small provision of the 2021 Consolidated Appropriations Act paves the way for Medicare patients to eventually pay no coinsurance for colorectal cancer screening tests when they become diagnostic. CMS finalized how that guideline will be enacted in the 2022 Medicare Physician Fee Schedule. READ MORE
When claims are denied by Medicare, providers have the right to appeal the decision. In fact, providers can appeal a decision up to five times–all the way to a judicial review in U.S. District Court–if they disagree with the rulings. But not all denials merit an appeal, and when they do, each level of appeal is different and must be sent to a different contractor. Wondering if an appeal is your next step? Here’s how to know when you should appeal and at what level and where to send it. READ MORE
Emergency departments serve on the frontline of the fight against drug overdoses and opioid use disorder. While there have been several barriers to providing and billing for medication assisted treatment in the ED, many of those barriers have been reduced or eliminated. When emergency physicians do administer and/or prescribe MAT, here’s what they should document and code for their services. READ MORE
The Medicare Place of Service Workgroup recently revised the telehealth place of service codes to reflect the need for greater specificity in the industry. While Medicare itself has not identified a use for the update within their own billing guidelines, they’ve made changes because “the healthcare industry has a greater need for specificity than Medicare” and “this eases coordination of benefits and gives other payers the setting information they need.” READ MORE
As we prepare for 2022, the Centers for Medicare and Medicaid Services (CMS) has released a variety of information healthcare providers need to know about billing Medicare in the new year. We’ve created a short list of the top seven things providers should know. READ MORE
