American Physician Financial Solutions

Diligence and documentation are the keys in receiving payment for a claim that somehow moves sideways. We recently had an ablation from October, 2014 that went sideways with Harvard Pilgrim. The claim was submitted in a timely fashion. This is documented from both the Practice Management system and from Harvard Pilgrim since they sent us […]

Anthem’s Medicare Advantage department recently published an Outreach and Education Bulletin regarding Outpatient Diagnostic Imaging. A copy of the full bulletin can be found using the link below. Beginning November 1, 2015 Anthem Medicare Advantage will begin collecting information about contracted providers that provide a variety of diagnostic imaging services which will include ultrasound services. […]

One of the questions I receive from different physicians throughout the year is: “Will phlebology still be in existence and paid for in the years to come?” My initial answer is “I sure hope so” since we are as invested in phlebology as that physician. My real answer is that I expect the payers to […]

More payers are applying increased scrutiny to diagnostic services, with diagnostic imaging at the forefront of this trend. Diagnostics have gotten a bad rap over the last several years as the target in several whistleblower cases and audit recoveries requiring several million dollars in refunds collectively. Medicare of FL routinely requests medical records for these […]

While Halloween may have just passed, the Witch Hunt apparently is just beginning. Two different physicians in two different states who have Noridian as their Medicare Administrator (MAC) have received letters noting a PRE-Payment audit of some of their claims. The first practice is having their ablations (36475) audited while the second is having their […]

The question regarding what you can do and cannot do during a free consultation has come back to us. As many practices offer some sort of free consultation as a marketing tool, we decided to readdress this question. Medicare has some guidelines of which one should be aware. Medicare has significant issues with anything that […]

In the last couple of years and certainly in the last 6 months we have seen a lot of audit requests. These have ranged from a simple 1 or 2 chart request from Medicare Advantage plans, to CERT (comprehensive error rate testing) requests, to Medicare pre-payment audits of several patients’ charts, and even a site […]

One of the three topics discussed at the American College of Phlebology Foundation’s (ACPF) Executive Leadership Summit was Advocacy. How can the ACP and the ACPF be an advocate for the phlebology practices that are members (and not yet a member)? Exactly what does that look like? In my mind’s eye, one of the largest […]

IDC10 becomes a reality on October 1st, 2015, just a couple short months away. Even though the new diagnostic codes will not be accepted on claims until this date, some payers will be requiring the new codes for authorizations that will be effective after the first of October date. Be sure that your authorization coordinator […]