DON’T IGNORE PATIENT CREDIT BALANCES

by Cheryl Nash Credit balances are notoriously ignored in the daily operations of a medical office. With the priority placed on satisfying positive balances, the negative ones tend to be shoved to the side until a rainy day or the end of the year rolls around.   News flash- Do Not Do This!   Most […]

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UNITED HEALTHCARE POLICY CHANGES

by AJ Riviezzo United Healthcare (UHC) came out with a new policy dated September 1, 2019, Policy Number 2019T0447Y. The policy still allows the treatment of GSV that are at least 5.5mm and SSV that are 5.0mm along with perforators underlying an ulcer and 3.5mm in size. Other criteria must also be met.   Of […]

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2020 PROPOSED MEDICARE REIMBURSEMENT

by AJ Riviezzo   Medicare just released their proposed rules. While there is a lot of information to unpack in the documents, there are some notable elements that will impact the phlebology community. First and foremost is the change in reimbursement for some codes.   In an effort to bring costs in line with reality, […]

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Non-Thermal Technologies and Medicare

by AJ Riviezzo   The various Medicare administrators (MACs) have been allowing the non-thermal technologies (ClariVein, Varithena and VenaSeal) to be paid (First Coast Service Options covering Florida/Puerto Rico does not cover ClariVein unfortunately). However, the language in the various Local Coverage Determinations by most of the MACs has not been updated. This leads to […]

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VARITHENA USE AND CODING

by Cheryl Nash   The question of how to bill for Non-Compounded Foam, commonly known as Varithena, has caused some confusion in phlebology circles, so we thought we would clarify some of the most commonly asked questions presented to APFS.   Q. We have been told we can use Varithena to treat tributaries, is this […]

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ANTHEM PRE-PAYMENT REVIEW

by Cheryl Nash   It has come to our attention that Anthem is initiating pre-payment reviews for frequently billed Varicose Vein CPT codes including 36470 and 36471 along with ablative codes 36465-36479. A conversation with a reviewer revealed this is in their nationwide markets and many providers may be affected.   It was advised that […]

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BREAKING NEWS REGARDING NOVITAS

by AJ Riviezzo   Novitas had come out with a new Local Coverage Determination outlining some changes in sclerotherapy usage, but more importantly they denied coverage for all of the new non-thermal technologies. The implementation date was supposed to be March 21st. For whatever reason it is now back to a Pending status for implementation. […]

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NEW MEDICARE AUDIT CONSIDERATIONS

by Cheryl Nash   Recently a client alerted me to a Medicare audit they received. Aside from the usual pull list for medical records, an interesting additional request caught our attention. On this occasion Medicare also asked for “a copy of licenses and/or certifications for all personnel documenting in the beneficiary’s chart or performing services.” […]

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ARTERIAL STUDIES

by Cheryl Nash   If your practice is performing peripheral arterial studies, the guidelines for doing so are very stringent as compared to venous studies. The list defining medical necessity for arterial scans is lengthy and should be read in its entirety for any physician currently doing or thinking about adding these services to their […]

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NON-THERMAL ABLATIONS AND THE PAYERS

I have had a number of conversations with our clients and others regarding non-thermal ablations. Unfortunately, the majority of these conversations are in regards to difficulties in obtaining reimbursement. Here is our rather conservative approach to these newer technologies and newer codes.   Review the Policy – This is the safest way in ensuring proper […]

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