Authorizations

Grab a Bunchby AJ RiviezzoWhen obtaining the authorization for the ablation, we also recommend obtaining the authorization for any additional services you routinely provide. Let us presuppose in your practice you average one phlebectomy for every two ablations and one to two medically necessary sclero procedures for every ablation. When obtaining the authorization for the […]

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Coding Clarification

Stabs 1 – 9by Cheryl Nash and AJ RiviezzoIn the past, there have been some variances in the code used for noting less than ten stabs performed during a phlebectomy. The new guidelines have clearly defined using the 37799 code. You must note the number of stabs actually performed in block 19 of the CMS-1500 […]

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The History and Physical

Your Presentation of the Patient to the Payer by AJ Riviezzo, MBAWe have been noting, for several years now, the importance of documentation to ensure your practice can survive an audit. We now have a real life customer that has been on the receiving end of a ZPIC audit. The key issue upon which the […]

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Sclerotherapy Injections

One Lump or Two?by Cheryl Nash and AJ RiviezzoMany practices are in the habit of automatically using the CPT code 36471 – sclerotherapy injection. We would caution selecting the correct code based on the number of veins injected. Code 36471 is used for injection into two or more veins. If only one vein is being […]

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January Marketing Tip

Medicare Appreciation Monthby Marcy Riviezzo and AJ RiviezzoUnless we have completely scarred you off from seeing Medicare patients, January is a good month for treating your Medicare patients. The reason for this is deductibles. Your commercial patients have typically just entered their new deductible cycle for the year. They may be reticent to begin treatment […]

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Free Screenings

Federal Anti-Kickback Laws by AJ Riviezzo, MBAOur last email contained information regarding ZPIC audits. This generated a discussion with Dr. Calcagno regarding potential concerns with performing free screenings on federal health care program patients (Medicare, Medicaid, TriCare, CHAMPUS, VA, CHP or Indian Health Service). It turns out there is some cause for concern. The Office […]

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Diagnosis Coding

A New Delay Scenarioby Cheryl Nash and AJ RiviezzoWhen coding (diagnosis) for a diagnostic ultrasound and new patient visit, we recommend coding with the patient’s presenting complaints and symptoms. For example, if the patient has swelling of the legs as well as pain in the legs then you would use the ICD-9 codes for these […]

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Review the Payer Guidelines

Knowledge is Essential by Cheryl Nash and AJ RiviezoMost commercial insurances and Medicare have clinical guidelines they review one to two times per year. It is essential that you are operating under the most current guidelines. As the United example shows, the changes can be dramatic and result in denials. One way to ensure you […]

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ZPIC Audits

Is Phlebology Being Targeted? by AJ Riviezzo, MBA The new Zone Program Integrity Audits (ZPIC), which have been in the making for several years, have really begun to be conducted over the past three months. The goal of these audits is to detect fraud and abuse in Medicare claims. These audits are being done by […]

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United Health Care Update

Positive Change for Once by Cheryl Nash and AJ RiviezzoUnited Health Care, effective October 25th, 2010, has again revised their medical policy guidelines for ablations. The submission of color photographic prints is no longer required. Also, the submission of US prints is no longer required. It appears their system could not handle the massive amount […]

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