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What Guidelines will Medicare follow for Pneumoccal Vaccine?

As you may recall, in November we reported that although the Advisory Committee on Immunization Practices (ACIP) had updated its guidelines regarding pneumococcal vaccines, Medicare had not changed its...

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Are you billing medicaid correctly since the ACA Increased Reimbursment ended?

Because the ACA PCP rate increase ended on December 31, 2014, billing instructions have been updated for Vaccinations and Nurse Practitioners. Nurse Practitioner billing During the increased PCP rates...

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CMS Instructions do not Follow CPT Guidelines

Have you researched a coding subject to then find differing answers?   Wisconsin Physician Services (WPS) has recently reiterated that there are times when the Current Procedural Terminology (CPT)...

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Medicare Holding 2015 Claims

On November 13, 2014, the CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after...

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Will you get paid for Screening for Hepatitis C Virus (HCV) in Adults?

According to MLNMatters MM871 (implemented January 1, 2015), effective June 2, 2014, CMS began to cover screening for HCV with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared...

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United Healthcare Adopts ACOG Hysterectomy Opinion

Beginning April 6, 2015, United Healthcare will use ACOG’s Committee Opinion 444, Choosing the Route of Hysterectomy for Benign Disease. Per ACOG, “evidence demonstrates that, in general, vaginal...

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Increase your Revenue with Chronic Care Management Services

Are your physicians billing chronic care management?  If not, read further to learn how your physicians or non-physician practitioners’ (NPP)  maybe able to increase their revenue.   This work is more...

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Consultation Codes No longer Covered by Indiana Medicaid

The Indiana Health Coverage Programs (IHCP) has decided to follow Medicare’s direction and no longer cover Consultation Codes 99241-99245 and 99251-99255. This coverage change also applies to...

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Confused about Modifier 78 and 79

Modifier 78 and 79 have been around for years now, but are you using them correctly for all payors? United Healthcare and Anthem Medicare Advantage plans as of 2015 are adopting the CMS rule for...

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Anthem Delays in Payment due to New Member Identification Prefixes for 2015

With the first of the new year and insurance carrier changes, you can almost always expect that the member insurance cards and /or policy numbers will change. If you are not asking your patients to see...

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