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
 
07/09/15 | Total joint issues from CMS
  Total joint issues from CMS
Total joint issues from CMS
 
12/31/14 | Holding claims and fee schedule issues for 2015
  Medicare wants claims held starting Jan 1, 2015
Holding claims and fee schedule issues for 2015
 
08/20/14 | Medicare finally catching on that modifier 59 is not enough
 
Medicare finally catching on that modifier 59 is not enough
 
07/22/14 | Keep an eye on your private payer contracts..
 
Keep an eye on your private payer contracts..
 
07/22/14 | Proposed 2015 Fee Schedule is out
 
Proposed 2015 Fee Schedule is out
 
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If you billed for any therapy services as of Jan 2013 and you got an EOM from Medicare stating "beneficiary liability (Group Code “PR”)" it was processed wrong and you will need to refund ASAP to the patient ---
Here is what was recently released...

"Change to Payment Liability for Therapy Cap Denials

Section 603(c) of the American Taxpayer Relief Act of 2012 (ATRA) changed the payment liability for denials resulting from the outpatient therapy caps from beneficiaries to providers effective January 1, 2013. Medicare systems were not updated in time to accurately represent this change on provider remittance advices (RAs). Medicare contractors may have already processed therapy cap denials for services provided in 2013. These denials incorrectly report on RAs beneficiary liability (Group Code “PR”) when liability legally rests with the provider (Group Code “CO”).

Due to differing claims processing system constraints, this inaccurate RA reporting will be corrected beginning on different dates for different claim formats. For institutional claims, the correct liability will be reported beginning on June 24, 2013. For professional claims, the correct liability will be reported beginning on January 1, 2014.

Since Medicare’s payment amount for these claims is correct, Medicare Administrative Contractors will not adjust claims processed before these dates to correct the Group Code. To do so could create disruptions for providers’ accounts receivable. Instead, therapy providers should review any therapy cap denials for dates of service on or after January 1, 2013, to determine whether any payments have been collected from beneficiaries. Providers should refund any beneficiary payments they find for these services. Additionally, providers should cease to collect payments for therapy cap denials unless the beneficiary was appropriately notified via an Advanced Beneficiary Notice of Noncoverage (ABN)."