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 called the “Stark law” after Pete Stark, the Congressman credited with introducing it. While many of the changes loosen the law’s restrictions, focused particularly on…
January 28, 2022 | By David Glaser The No Surprise Billing Act may be the most poorly written, difficult to understand set of regulations I have encountered in my legal career. Stark is much, much easier to understand. Much of the guidance out there is misleading, if not entirely wrong. Here is a short…
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 of the chief targets of these efforts is the process by which providers obtain Medicare billing privileges (“enrollment”). Without being enrolled in Medicare, a provider…
September 4, 2020 | By Brenda Edwards, CPC, CDEO, CPB, CPC-I, CEMC, CRC, CMRS, CMCS Is anybody not aware of the Evaluation and Management (E/M) changes coming in January 2021? Have you asked your administrator, managers, front office, back office, and providers if they are ready for these major changes? Anybody that touches CPT® 99202-99215…
November 20, 2020 | By Brenda Edwards, CPC, CDEO, CPB, CPC-I, CEMC, CRC, CMRS, CMCS COVID-19 has been disrupting the healthcare environment for over a year now. Massive changes and evolutions have been introduced for how to code for services during COVID-19 including virtual visits, lab testing, and vaccinations. This article will cover COVID-19…
May 29, 2020 | by Anna McGregor, CLP, CPC, CPCO, CPMA, CEMC, CEMA | Director for Coding Integrity, Texas Tech University Health Sciences Center/School of Medicine Like a sandstorm, CMS has clouded our coding world in chaos, leaving us to ponder whether all these new flexibilities will become the new standard. Leading up…
May 28, 2021 | Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content, innoviHealth Prolonged services codes were created to capture reimbursement for time spent with a patient that goes beyond the typical time associated with the primary service. We’re all aware of those patients that, unexpectedly, require so much prolonged provider…
Have you ever had one of those questions that you think you have the answer to, but the more you read it, the more you’re swayed the other way — and then you read it again and you have an even different answer? Well, one of our NAMAS members (and a friend of mine) emailed…
May 20, 2022 | By Toni Elhoms, CCS, CPC, CPMA, CRC Over the past year and a half, I have seen a significant increase in the volume of Unified Program Integrity Contractor (UPIC) investigations taking place in private physician practices. UPICs work on behalf of CMS to perform program integrity functions like detecting fraud,…
May 6, 2022 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT A great deal of time was spent this year with new coding updates focusing on critical care split shared updates, but not much time was given to all of the other red-lined updates in the critical care section of the CMS Claims…