Coding Guidelines for Skin Substitute Grafts

Recently on July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces the proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. This proposed rule also suggested some changes for skin substitute […]


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Proposed Billing Guidelines for Opioid Treatment Programs (OTPs)

Medicare Physician Fee Schedule Proposed Rule Recently on July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces the proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023.  Revised Pricing for Drug […]


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Expanding Medicare Telehealth Use after PHE

CY 2023 Medicare Physician Fee Schedule Proposed Rule On 7th July 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, […]


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Common Outpatient Rehabilitation Therapy CERT Errors

Billing Part B Outpatient Therapy Services Outpatient rehabilitation therapy includes Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) services. Medicare covers outpatient PT, OT, and SLP services when: A physician or Non-Physician Practitioner (NPP) certifies the “treatment plan,” called the Plan of Care (POC), ensuring: A patient needs therapy services  POC is:  Established […]


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Instructions for SNF Advanced Beneficiary Notice of Non-coverage (SNFABN)

SNF Advanced Beneficiary Notice of Non-coverage Medicare requires SNFs to issue the SNFABN to Original Medicare, also called fee-for-service (FFS), beneficiaries prior to providing care that Medicare usually covers, but may not pay for in this instance because the care is not medically reasonable and necessary; or considered custodial. The SNFABN provides information to the […]


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Primary Care Physicians Can Earn More with Outsourcing

PCPs are Leaving Money on Table According to a recent study published in the Annals of Internal Medicine, primary care physicians left a large amount of money on the table for services that were provided but not coded and billed. This research estimates that a single primary care physician could add $124,435 in preventative services […]


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The Federal Government Investigating COVID-19 Fraud

COVID-19 Fraud The federal government is broadening its multi-agency law enforcement effort to address pandemic-related fraud beyond Paycheck Protection Program (PPP) related cases to encompass alleged instances of healthcare-related COVID-19 fraud. The subjects and targets of these investigations and prosecutions include alleged bogus telemedicine encounters, falsifying COVID-19 vaccination cards, and the misuse of healthcare provider […]


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Role of States in Exclusion of Ground Ambulances from NSA

Exclusion of Ground Ambulances from No Surprises Act The No Surprises Act (NSA) will prohibit most surprise bills, reducing out-of-pocket costs for emergency services and non-emergency services where the patient unintentionally sees an out-of-network provider. The recently enacted No Surprises Act (NSA) provides landmark protections against surprise billing in a wide range of settings but […]


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Understanding Medicare TPE Audits

The Centers for Medicare & Medicaid Services (CMS) is resuming the Targeted Probe & Educate (TPE) audit, effective September 1, 2021. Based on data analysis of claims payment, CMS will identify areas with the greatest risk of inappropriate program payment. CMS’s Targeted Probe and Educate (TPE) program is designed to help providers and suppliers reduce […]


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Medicare Coverage for Vagus Nerve Stimulation (VNS)

Vagus Nerve Stimulation (VNS) is a pulse generator, similar to a pacemaker, that is surgically implanted under the skin of the left chest and an electrical lead (wire) is connected from the generator to the left vagus nerve. Electrical signals are sent from the battery-powered generator to the vagus nerve via the lead. These signals […]


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