American Physician Financial Solutions

There is a bit of a shift in commercial insurance contacting of which you may want to be aware.  If you are an established provider with established contracts, there are still some changes we have seen that could impact you.  If you are looking at starting a practice, then we definitely have some information you […]

Conservative Management- that’s the buzz term you need to know in insurance coverage policies. But what does this mean to your practice?  Probably not what you would like to hear.   Management means medically supervised conservative treatment, and while this includes prescription strength compression stockings that have been properly measured and ordered, it also means […]

In the last article I wrote about coding for sedation services.  I briefly touched on the coding and reporting requirements for moderate sedation.  In this article, I will elaborate on that and provide a breakdown of what is needed to report these services.   In 2017 the codes for physician reporting of moderate or conscience […]

Noridian has released letters informing providers of a new pre-payment review called the TPEE- Targeted Probe and Education with Extrapolation review. This is a pilot program and if successful may become a part of the CMS integrity program.   Noridian states that this review will consist of a prepayment process designed to educate the provider […]

Coding and Billing for sedation services tend to cause confusion for providers that are not accustomed to such billing practices. Services such as tumescent, anoxiolysis, and moderate sedation get mixed up with the codes that are out there for general anesthetic services. For clarity, these services have specific definitions and attendant work requirements and/or certification […]

Over the past year or two, there have been some rather substantial changes in policies and Local Coverage Determinations (LCD).  Of note has been Blues of North Carolina restricting ablations to one per limb per lifetime.  This was not a medical policy change but a coverage change enacted by Blues to save money.   Currently […]

As my article above outlines, Novitas has come out with a new policy that greatly curtails the ability to treat patients in a prudent and effective manner.  I want to assure our readers that there is a concerted effort to provide commentary to Novitas regarding the exclusion of specific language allowing CEAP 2 and 3. […]

Phlebology is somewhat unique in the variety of physicians with very different American Board of Medical Specialties (ABMS) certifications.  Sometimes that variety presents a challenge when benefits are communicated by the payer to the coworker at the practice.  The computer system that the payer representative is looking at likely compares benefits against your primary ABMS […]

If your practice is in North Carolina I am sure you are aware of the changes in benefits that BCBS NC has implemented beginning the first of the year.  For those of you who sometimes see a Blues patient from North Carolina, you should also be aware of these changes.   As of December 30th […]

Vascular Insights, LLC has obtained CPT codes through the AMA for their ClariVein mechanochemical system.  The codes are 36473 for the first vein treated and code 36474 for the subsequent vein treated.  Only the RVU’s are readily available at this moment.  Based on the RVU calculations, reimbursement should come in just under the RF (36475/36476) reimbursement […]