Urgent Response To CMS Needed
The Centers for Medicare and Medicaid Services (CMS) is moving towards decreasing reimbursement for complete diagnostic ultrasounds (93970) to the same level as a limited ultrasound (93971). Currently they are in the process of grouping these two services in the… Read More
A/R Best Practices
One of the biggest concerns in a practice is their collections. Getting patients in the door is only half the battle. Having their claims processed to completion is the natural outcome, but at times this seems to be the portion… Read More
Time For A New Code?
One of the larger frustrations over the past few years has been the increasing denial of the US guidance code (76942) when performing sclerotherapy. A few large commercial payers, many small commercial payers and even one Medicare regional administrator will… Read More
But I Have An Authorization!
Some of the practices with whom I’ve worked had a similar statement. The practice had received an authorization for services that was not being honored by the claims processing department. There is actually a lot happening behind the scenes in… Read More
Six Ways To Fail An Audit
In working claims for our billing clients, conducting audits as part of our consulting services, and in assisting practices going through a Medicare or commercial audit, we have noted a few trends that the payers focus on. Below are some… Read More
Insurance Contracting
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. … Read More
Accepting The Patient’s Word…
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… Read More
Sedation Services Billing — Part 2
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… Read More
New Audit By Noridian
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… Read More
Sedation Services Billing — Part 1
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… Read More