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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Accessing Newsletters
01/02/19 | Calendar events

Calendar events

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Current law requires CMS to adjust the MPFS payment rates annually based on an update formula which requires application of the Sustainable Growth Rate (SGR) that was adopted in the Balanced Budget Act of 1997. This formula has yielded negative updates every year beginning in CY 2002, although CMS was able to take administrative steps to avert a reduction in CY 2003, and Congress has taken a series of legislative actions to prevent reductions in CYs 2004-2009. In the absence of Congressional action for the CY 2010 physician update, the final rule with comment period will reduce the conversion factor for services on or after Jan. 1, 2010 by 21.2 percent rather than the -21.5 percent projected in the proposed rule. The difference is due to the use of the most recently available data on CMS spending for physicians’ services.

 CMS is also finalizing its proposal to stop making payment for consultation codes other than the G codes that are used to bill for telehealth consultations, and to redistribute the resulting savings to increase payments for the existing evaluation and management (E/M) services. CMS will adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during the global period. In the final rule with comment period, CMS is adopting two significant modifications to its proposal to increase the equipment utilization percentage that is assumed for purposes of setting PE RVUs. CMS will increase the equipment utilization rate assumption used to determine the practice expense for expensive equipment priced over one million dollars from 50 to 90 percent but will phase in this change over a four year period. CMS also will not apply this change to expensive therapeutic equipment.

The final rule with comment period contains a number of provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative (PQRI). Specifically, the final rule simplifies the reporting requirements for the electronic prescribing measure, provides eligible professionals with more reporting options, and establishes a new process for group practices to be considered successful electronic prescribers. Eligible professionals or group practices that meet the requirements of each program in CY 2010 will be eligible for incentive payments for each program equal to 2.0 percent of their total estimated allowed charges for the reporting periods. In addition, CMS is adding measures for eligible professionals to report under the PQRI, providing a mechanism for participants to submit quality measure data from a qualified electronic health record and creating a process for group practices to use for reporting the quality measures. The final rule with comment will appear in the Nov. 25, 2009 Federal Register. CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010. To view a copy of the final rule with comment period, please see:
www.federalregister.gov/inspection.aspx#special A fact sheet providing more information about the e-Prescribing

New for Jan 2010:

Check out the new guidelines just release regarding CMS deleting of coverage of consultations:


Many offices are going to find out the hard way that just saying in your (the Consultant's) note that you are seeing the patient  "In consultation for Dr PCP for a left knee injury" and rendering an opinion and then replying back will not be enough to support the guidelines.

Since 1995, the Documentation Guidelines have been clear under the MDM section that if you are sending for a consultation you must document to "whom" and "why' to support the request.

Here is a great Q&A from a Medicare Carrier when they were ask about this very issue:

Q12. If the consultant's report, which mentions the request, reason and findings, is the only documentation relating to the CONSULTATION in the requesting provider's medical records, does this comply with Medicare guidelines for reimbursement of a CONSULTATION?

A12. It may be that this will be the only recoverable evidence should a CONSULTATION service be audited. It would be expected that this might occur at times, and the consulting physician has no control of what information is contained in the referring physician's chart. However, this does not alter the requirements for a CONSULTATION, and in an audit, were such a question to come up, and there were repetitively no such records in any referring physician's notes, then the veracity of the consultant's notes could logically be questioned.

This should not be a major worry or concern to providers who know they've been honestly referred a CONSULTATION &but would just not be a protection for physicians who are "creatively interpreting" patients referred for, or self-referring for care, with "CONSULTATIONs".  Medicare Part B Bulletin #227 NORIDIAN: APR 06 Publish Date April 2006 States Affected AK AZ CO GU HI IA ND NV OR SD WA WY UT

Be on the safe side and get the request in writing, if you need a sample form, just send me an email and I will send you one you can use or adjust, etc.