Things to Know Prior to Implementation of Radiation Oncology Model

Introduction to Radiation Oncology Model The Radiation Oncology Model aims to improve the quality of care for cancer patients receiving radiotherapy (RT) and move toward a simplified and predictable payment system. The RO Model tests whether prospective, site-neutral, modality agnostic, episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD), and freestanding radiation therapy […]

Why Credentialing is Important for Healthcare Professionals?

Medical provider credentialing is a process through which healthcare facilities and insurance companies access and confirm the qualification of a provider. The process is vital as it helps maintain high standards in healthcare. Since credentialing tells us whether a provider has the necessary training or expertise to practice healing arts, it is paramount for everyone […]

Impact of 2023 MPFS Proposed Rule on Neurology Billing

2023 Medicare Physician Fee Schedule Proposed Rule Recently, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 revisions to payment policies under the Medicare Physician Fee Schedule (MPFS) and other changes to the proposed rule for Medicare part B payment policies (CMS-1770-P). In this article, we shared the impact of the 2023 […]

Understanding False Claims Act in Healthcare

False Claims Act in Healthcare The False Claims Act (FCA) in healthcare (also called the ‘Lincoln Law’), is a federal law that imposes liability on persons and companies who defraud governmental programs. It is the federal government’s primary litigation tool in combating fraud against the government. The federal False Claims Act makes it illegal to: […]

Coding Guidelines for E&M Services

CPT codes for Evaluation & Management (E&M) services are principally included in the CPT code range 99202-99499. The codes describe the site of service (e.g., office, hospital, home, nursing facility, emergency department, critical care), the type of service (e.g., new or initial encounter, follow-up or subsequent encounter), and various miscellaneous services (e.g., prolonged physician service, […]

Medical Billing for Cardioversion

Basics of Cardioversion Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. For medical billing purposes, cardioversion has been coded as an external and internal procedure. CPT codes 92960 (cardioversion, elective, electrical conversion of arrhythmia; external) and […]

Billing Guidelines for Bilateral Surgeries

Bilateral Surgeries Billing Bilateral surgeries are procedures performed on both sides of the body during the same operative session or on the same day. Medicare makes the payment for bilateral procedures based on the lesser of the actual charges or 150 percent of the Medicare Physician Fee Schedule (MPFS) amount when the procedure is authorized […]

Increased Coverage of Interprofessional Consultations

On 5th Jan 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued guidance that creates an easier path to specialty care for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. This increased coverage of interprofessional consultations allows direct payment to consulting practitioners, expanding access […]

Covered Destinations for Ambulance Transportation

Basics of Destinations for Ambulance Transportation Ambulance transport is covered to the nearest appropriate facility to obtain necessary diagnostic and/or therapeutic services such as a CT scan or cobalt therapy as well as the return transport. In addition to all other coverage requirements, this transport situation is covered only to the extent of the payment […]

Arthroscopy Coding Guidelines

Basics of Arthroscopy Coding Guidelines To share arthroscopy coding guidelines, we referred National Correct Coding Initiative (NCCI) policy manual. CMS developed the NCCI manual to promote national correct coding of Medicare Part B claims. The Medicare NCCI promotes correct coding methodologies and controls improper coding leading to improper payment. Before going into detail about arthroscopy […]

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