09/26/18 | Scam audio flyer Fionexia - please don't sign up
 

It has come to my attention that there is a flyer (from Fionexia) that is going out from a company that is fraudualent and stating I am doing an audio for them.  Please do not sign up it is a scam.  The audio they are advertising was done for AudioEducator.com. It appears if you pay for it you may not get anything for your pay!!!

Scam audio flyer Fionexia - please don't sign up
 
08/11/18 | Margie Vaught Newsletters
 

Now you can access and download the newsletters directly from this site. 

Margie Vaught Newsletters
 
07/20/18 | 2019 Proposed Fee schedule released
 

Proposed 2019 Fee Schedule is out – hang on to your seats…

CMS released the 12th of July the proposed changed for the physician fee schedule for 2019 (https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2018-Press-releases-items/2018-07-12.html).

2019 Proposed Fee schedule released
 
07/20/18 | CPT updates policy of 63047 with 22633
 

CPT updates their policy regarding nerve root decompressions and interbody fusions

AANS, NASS and AAOS have been working hard on getting CPT to change their previous October 2016 CPT Assistant regarding nerve root decompression 63047 and interbody fusion 22633 being inclusive

CPT updates policy of 63047 with 22633
 
03/05/18 | Total knee arthroplasty (27447) removed from Inpatient only list – causing confusion
 

You may have been experiencing feedback from a facility when trying to schedule your total knee replacements as inpatients. 

Total knee arthroplasty (27447) removed from Inpatient only list – causing confusion
 
07/10/17 | New Category III codes effective Jan 1st, 2018
 

You will want to update your bone marrow aspiration coding for 2018 as well as some adipose-derived cell therapy for hands

New Category III codes effective Jan 1st, 2018
 
07/10/17 | Spinal surgery
 

If you do any spinal surgery you want to be aware of the Medicare changes that are taking place regarding number of levels, number of cages as well as diagnosis issues.

Spinal surgery
 
06/10/16 | CMS starting to list ICD-10s not covered
  Unspecified ICD-10 codes be careful
CMS starting to list ICD-10s not covered
 
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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.