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Know the reimbursement rules for students working in your medical practice. Many medical offices and clinics allow medical students to train in their practices to gain invaluable clinical education and experience. It’s important to support students with this much-needed hands-on work and training. There are some legal implications associated with billing for students’ work, however; […]
The post Billing Implications for Medical Students appeared first on AAPC Knowledge Center.
Two Texas medical practices to pay more than $ 500,000. The attorney for the Western District of Texas has announced separate civil settlements totaling $ 513,168.10 to resolve allegations that two area medical practices violated the False Claims Act (FCA) by improperly billing Medicare for P-Stim devices. Medicare does not pay for acupuncture or acupuncture devices like […]
The post FCA Violation Settled for Fraudulent Billing of P-Stim Devices appeared first on AAPC Knowledge Center.
Consider this otolaryngology case study to decide when to append modifier 25. The Cigna Group recently postponed a requirement for documentation to be submitted with all claims that include a 25 modified office or other outpatient evaluation and management (E/M) service (CPT® 99212-99215) and a minor procedure. Although the payer didn’t follow through on this […]
The post Billing an E/M With a Minor Procedure: Yes, You Can! appeared first on AAPC Knowledge Center.
Make an informed decision when choosing a company responsible for your reimbursement. If you’re a physician looking to boost your reimbursement rates, increase your financial performance, save on operating costs, or devote more time to patient care, outsourcing your billing needs is the way to go. Not all physician billing services are the same, however. […]
The post 5 Qualities of a Great Physician Billing Solution appeared first on AAPC Knowledge Center.
Use midlevel providers to maximize productivity and reimbursement in your physician office. Physician assistants (PAs) are a type of nonphysician practitioner (NPP) who may bill Medicare under their own national provider identifier (NPI). As of Jan. 1, 2022, PAs can bill and be reimbursed directly from Medicare where previously reimbursement could only be made to […]
The post Billing a PA’s Services Incident to a Physician’s appeared first on AAPC Knowledge Center.
Healthcare provider pays for billing Medicare before services were fully performed. In U.S. ex rel. Montcrieff v. Peripheral Vascular Associates, 2023 WL 139319 (W.D. Tex. 2023), the court indicated it will award a minimum of $ 24 million in total damages, fines, penalties, and sanctions based upon a medical practice’s purported violation of the False Claims […]
The post A Case of Fraudulent Billing or Common Practice? appeared first on AAPC Knowledge Center.
Is modifier 95 required on every code furnished via telehealth? After reading “Take the Complexity Out of Behavioral Health Coding” in the June 2022 issue of Healthcare Business Monthly, a reader asked: “If billing 96130, G0396, and 90791, would I use modifier 95 on all three of these procedure codes in addition to the U4?” […]
The post Billing Multiple Behavioral Services appeared first on AAPC Knowledge Center.
Keep this table handy to apply new modifiers JK and JL correctly starting in May. Durable medical equipment (DME) suppliers and pharmacies that provide insulin pumps or insulin for pumps need to be aware of the following key points about upcoming Medicare changes under Part B. Comply With the Coinsurance Cap Starting July 1, 2023, […]
The post Changes Are Coming for Billing Insulin in DME Pumps Under Medicare appeared first on AAPC Knowledge Center.
Did you know that tetanus vaccines are only covered under Medicare Part B when given for treatment? Preventative tetanus vaccinations are non-covered. I found this hard to believe, so I looked it up. Sure enough, the Centers for Medicare & Medicaid Services Internet-Only Manuals Pub. 100-02, Chapter 15, Section 50.4.4.2 states, “Vaccinations or inoculations are […]
The post Billing for Tetanus Vaccine? Check the Diagnosis appeared first on AAPC Knowledge Center.
Medicare reminds healthcare providers of an important coverage change through claims denials. Ever since a public health emergency (PHE) for COVID-19 was declared on Jan. 27, 2020, there has been several new HCPCS Level II codes created for monoclonal antibody (mAb) products and administration. As confusing as all these new codes and billing requirements have […]
The post COVID-19 Monoclonal Antibody Billing Update appeared first on AAPC Knowledge Center.