This section provides the latest and essential industry updates as they become available.
Understand how Nurse Practitioners (NP) and Physician Assistants (PA) Qualify as Certifying Physicians for Therapeutic Shoes & Inserts
NPs and PAs who are practicing under the supervision of an MD or DO (i.e., “incident to”) as the certifying physician can provide therapeutic shoes to beneficiaries with diabetes if certain criteria are met
Excellus BlueCross BlueShield-Discontinuation of Paper Notification for Claiming Billing Errors
As of February 4, 2022, Excellus BlueCross BlueShield has discontinued its practice of sending paper notification when certain billing errors occur. This change is part of their overall effort to reduce the amount of paper sent to provider practices.
Why Providers Should Prioritize Billing & Coding Oversight
When a miscoded procedure is the result of substantial negligence or fraud, it can be detrimental to a medical practice or physician. That is why it is vital for medical practices to establish robust oversight, audit and remediation procedures that work to ensure accurate coding and billing.
NGS-Nail Debridement: CPT Codes 11719, 11720, 11721 and Paring or Cutting of Benign Hyperkeratotic Lesions: CPT Codes 11055, 11056, 11057
CPT code 11055 (Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion) and CPT code 11720 (Debridement of nail(s) by any method(s); one to five) should not be reported together for services performed on skin distal
Billing for Services when Medicare is Secondary
Don’t deny treatment, entry to a SNF or hospital, or services based on an open or closed Liability (L), No-Fault (NF) or Workers’ Compensation (WC) Medicare Secondary Payer (MSP) record on the beneficiary’s Medicare file or if a claim was inappropriately denied.
APMA-Successful with Initiative to Increase MUE for CPT 28300
The APMA has requested that the National Correct Coding Initiative (NCCI) increase the Medically Unlikely Edit (MUE) of CPT 28300 (Osteotomy, calcaneus) from one to two,
stating their argument; that this was necessary to account for the situation when a double calcaneal osteotomy is needed.
Post-Op Global Period Changes From 90 to Zero Days for Common Digital Amputation Procedures
The global surgical package for CPT 28820 (amputation, toe: metatarsophalangeal joint) and CPT 28825 (amputation, toe: interphalangeal joint) includes all the necessary services normally furnished by a surgeon before, during and after a procedure.
Major Stimulus Bill Pumps Funds into Healthcare
A $1.4 trillion government spending bill and $900 billion COVID-19 relief package, signed into law Dec. 27, includes a slew of provisions directed toward the Department of Health and Human Services, but one in particular will put money back into the pockets of healthcare practitioners.
Physicians/Practitioners: Medical Records Play a Vital Role in Ordering and Providing DMEPOS to Your Patients
For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient information about the patient’s medical condition to substantiate the necessity for the type of equipment or supply, quantity and/or frequency of use or replacement, if applicable.