5 / 16 / 2024
On April 1, 2024, the Centers for Medicare and Medicaid Services (“CMS”) finalized their Calendar Year (CY) 2025 rates for Medicare Advantage (“MA”) and Part D prescription drug programs....
4 / 25 / 2024
Every primary care physician (PCP) in the United States should be integrated into an accountable care model. The primary objective of accountable care models is to provide all participating...
4 / 23 / 2024
In January of 2021, the American Medical Association (AMA) released new evaluation and management (E/M) guidelines that simplified the documentation requirements for outpatient E/M services. On the heels...
4 / 23 / 2024
Recently, we have been getting questions about the new Healthcare Common Procedural Coding System (“HCPCS”) code G2211 (Visit complexity inherent to evaluation and management associated with medical care services...
4 / 17 / 2024
If you have questions about how to properly bill Medicare for bilateral procedures, the National Correct Coding Initiative (“NCCI”) policy manual has your answers. Starting on page 30 of...
4 / 3 / 2024
In this series of articles on the National Correct Coding Initiative (“NCCI”) Policy Manual, we have discussed procedure to procedure (“PTP”) edits and medically unlikely edits (“MUE”), but were...
3 / 28 / 2024
Introduction & Background Following the enactment of the Patient Protection and Affordable Care Act (PPACA) in March 2010, the healthcare industry has experienced a major shift in its reimbursement...
3 / 26 / 2024
In part one we discussed procedure to procedure (“PTP”) edits. In this article we will discuss Medically Unlikely Edits (“MUEs”). The Centers for Medicare and Medicaid Services (“CMS”) defines...
3 / 21 / 2024
Introduction March is Kidney Awareness Month, and Pinnacle wants to share updates regarding the new conversion from v24 to v28. What better way to celebrate than to brush up...
3 / 19 / 2024
In the introduction, we discussed the three (3) edit types that make up the National Correct Coding Initiative (“NCCI”). Probably the most familiar of those edits are the procedure...