Non-Medically Necessary vs. Statutorily Excluded Services: Understanding the Differences

Compliance, CPT, Payer Rules, Practice Management, Procedural Coding & Auditing, Revenue Cycle Management

Non-Medically Necessary vs. Statutorily Excluded Services: Understanding the Differences  Written by: Jennifer McNamara “That’s not covered.” It’s a phrase we hear all the time—but what does it really mean? There’s a definite distinction between non-medically necessary services and those that are statutorily excluded.  Understanding the difference between non-medically necessary and statutorily excluded services is essential…

Prevention of Patient Complaints and Payer Denials: Covered vs Non-Covered Preventive Services

Compliance, CPT, Payer Rules, Practice Management, Procedural Coding & Auditing, Revenue Cycle Management

Prevention of Patient Complaints and Payer Denials: Covered vs Non-Covered Preventive Services Written by: Pam Vanderbilt “I just got a bill for my free annual visit!!   Sound familiar? Calls from patients who are upset because they got a bill for services they thought were covered. When I research these complaints, the issue causing the services…

Cosmetic Services in Professional Fee Clinics

Compliance, Payer Rules, Practice Management

Cosmetic Services in Professional Fee Clinics: Compliance Considerations Written by: Jesse Overbay | Associate Director & General Cousel @ DoctorsManagement, LLC Overview of Cosmetic Services in Professional Fee Clinics Across many healthcare settings, including specialized and general clinics, an increasing number of providers are incorporating cosmetic procedures in response to patient interest and evolving treatment…

Telehealth 2025: Audio Only 1st Quarter

Telehealth

First published on TerryFletcher.netThis is a revision by the same author:Terry Fletcher CPC, CCC, CEMC, CCS, CCS-P, CMS, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM, PACS   We have been receiving many inquiries and emails regarding the billing of Audio Only Telehealth for Medicare and Commercially Insured patients starting January 1st, 2025. The published guidance is…