09/28/21 | CMS gives more insight into appropriate DOS for imaging
 

The Center for Medicare and Medicaid Services (CMS) has guidance for reporting the date of service (DOS) for various services. Information provided for global reporting, technical reporting and professional reporting

 

CMS gives more insight into appropriate DOS for imaging
 
07/01/21 | New CPT code for Subchondroplasty
 

Effective July 1st 2021 - the AMA released a new code for Subchondroplasties - are you ready for it

New CPT code for Subchondroplasty
 
03/17/20 | Telehealth regulations loosened
 

With the Coronavirus issues CMS has loosened the regulations and HIPAA issues that have caused concerns about when telehealth can be used. Check out the new release

Telehealth regulations loosened
 
01/29/20 | New Drug Delivery Codes 20700-20705
 

Stop using 11981-11983 as of Jan 1st 2020- Use the new drug delivery codes 20700-20705 --

New Drug Delivery Codes 20700-20705
 
04/04/19 | Watch your "stem cell" wording - On going FBI investigations
 

For those offices that are using the wording 'stem cells' or charging patients for these services you need to be aware of the FBI ongoing investigations.

Watch your
 
02/28/19 | Great article on the issues with 63047 and 22633 and 22630
 

Find out about the issues between 22633/22630 and 63047 and get the history of these codes.  Great information you can use for your private payer appeals.

Great article on the issues with 63047 and 22633 and 22630
 
01/02/19 | Accessing Newsletters
 

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01/02/19 | Calendar events
 

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For many years I have been harping on providers that they are lacking an 'official interpretation' in their office notes regarding imaging and that they are lacking an order for those images.  Well the OIG just released their findings on this topic.....

Just released from the OIG - official interpretation AND ordering

Medicare Payments for Diagnostic Radiology Services in Emergency Departments
OEI-07-09-00450
http://go.usa.gov/T70

In 2008, Medicare erroneously allowed 19 percent ($29 million) of claims for interpretation and reports for computed tomography (CT) and magnetic resonance imaging (MRI) and 14 percent ($9 million) of claims for interpretation and reports for x?rays in hospital outpatient emergency departments because of insufficient documentation.

Of the allowed Medicare claims for CTs and MRIs in hospital outpatient emergency departments in 2008:

(1) 12 percent ($18 million) did not have physicians’ orders as part of the medical record documentation and

(2) 12 percent ($19 million) did not have documentation to support that interpretation and reports had been performed.  Five percent ($7.3 million) had overlapping errors.

Of the allowed Medicare claims for x-rays in hospital outpatient emergency departments in 2008:
(1) 8.6 percent ($5.5 million) did not have physicians’ orders as part of the medical record documentation and

(2) 8.2 percent ($5.4 million) did not have documentation to support that interpretation and reports had been performed.  Three percent ($1.9 million) of claims had overlapping errors.

Although not erroneously allowed, 12 percent ($19 million) of CT and MRI claims and 16 percent ($10 million) of x-ray claims were for interpretation and reports that were performed after beneficiaries left emergency departments.

CMS offers inconsistent payment guidance on the timing for interpretation.  In 2008, approximately 71 percent of interpretation and reports for x?rays and 69 percent of interpretation and reports for CTs and MRIs did not follow one or more of the American College of Radiology-suggested documentation practice guidelines.

We recommended that CMS:
(1) educate providers on the requirement to maintain documentation on submitted claims,

(2) adopt a uniform policy for single and multiple claims for interpretation and reports of diagnostic radiology services to require that claimed services be contemporaneous or identify circumstances in which noncontemporaneous interpretations may contribute to the diagnosis and treatment of beneficiaries in hospital outpatient emergency departments, and

(3) take appropriate action on the erroneously allowed claims identified in our sample.


In its written comments on the report, CMS concurred with the first and third recommendations.  CMS did not concur with the second recommendation.  CMS indicated that it does not believe that a single billed interpretation must in all cases be contemporaneous with the beneficiary’s diagnosis and treatment to contribute to that diagnosis and treatment.  However, a uniform policy requiring that the interpretation and report be contemporaneous with, or, if not contemporaneous, demonstrably contribute to the beneficiary’s diagnosis and treatment could reduce unexplained complexity in what is already a complicated billing system for medical diagnostics.