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Category Archives: Payer Rules

The Year of the Audit: Stand Your Ground with Payers

Compliance, E/M Coding & Auditing, Legislative Action, Payer Rules, Sean WeissBy NAMASJanuary 22, 2021

  January 22, 2021 | By Sean M. Weiss, CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC Welcome to 2021, “y’all” – as we say down yonder in the beautiful South!…

Better late than never: Stimulus bill salves pain of conversion factor cut, also delays G2211

E/M Coding & Auditing, Grant Huang, News & Events, Payer RulesBy NAMASJanuary 8, 2021

January 7, 2021 | By Grant Huang, CPC, CPMA The 2021 Physician Fee Schedule (PFS) had included the largest one-year reduction to the Medicare conversion factor (CF) in more than…

Changes to Stark May Require Tweaks to the Physician Compensation Formula

David Glaser, Legislative Action, Payer RulesBy NAMASJanuary 8, 2021

  January 8, 2021 | By David Glaser In early December, the Centers for Medicare and Medicaid Services (CMS) issued new rules that dramatically revise the Physician Self-Referral Law, commonly…

After the Fire: Consideration of Risk-Based Contracts Post-COVID-19

E/M Coding & Auditing, J. Paul Spencer, Payer Rules, Revenue Cycle ManagementBy NAMASDecember 18, 2020

  December 18, 2020 | By Paul Spencer, CPC, COC “Risk adjustment,” as defined by CMS, is a method by which Medicare Advantage plans are compensated for demonstrating that the…

Finally: CMS releases 2021 final rule; no major surprises seen

2021 E&M Changes, E/M Coding & Auditing, Grant Huang, Legislative Action, Payer RulesBy NAMASDecember 10, 2020

  December 15, 2020 | By By Grant Huang, CPC, CPMA At long last, CMS has published its Medicare Physician Fee Schedule (PFS) final rule, and while some of the…

Insurance Coverage for COVID-19 Testing

Bryan Meek, COVID-19, Payer RulesBy NAMASNovember 13, 2020

  November 13, 2020 | By Bryan Meek, Esq., Brennan, Manna, and Diamond As the COVID-19 pandemic continues to wreak havoc globally, routine COVID-19 testing of employees, patients, and the…

Focus Providers on Clinically Relevant History and Exam, and Concise Medical Decision Making

2021 E&M Changes, E/M Coding & Auditing, Payer Rules, Scott KraftBy NAMASOctober 16, 2020

  October 16, 2020 | By Scott Kraft, CPMA, CPC It’s fair to say the 2021 changes to the E/M documentation guidelines ease the documentation burden on the rendering provider…

The Truth about 2021 E/M Changes

2021 E&M Changes, E/M Coding & Auditing, Payer Rules, Sean WeissBy NAMASJuly 24, 2020

  July 24, 2020 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Here we are, nearly at the end of July 2020 and we are neck deep…

Telehealth Exam Documentation

Compliance, Payer Rules, Scott KraftBy NAMASJune 5, 2020

June 5, 2020 | By Scott Kraft, CPMA, CPC During the rapid pivot to telehealth services during the COVID-19 pandemic, one of the biggest priorities has been staying on top…

Maintaining Medicare Enrollment: The Never-Ending High-Hurdles Race

Daniel Shay, Payer RulesBy NAMASFebruary 28, 2020

  February 28, 2020 | By Daniel F. Shay, Esq. Facing the mounting pressure of demographics, the Medicare system looks to slow the outflow of money however it can. One…

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