News and Articles

Read current and past news articles featuring coding and reimbursement topics for ophthalmologists and optometrists.

Search for a topic or choose a news piece or article from our library below.

TitleSummaryTypeDate
CMS Extends Deadline for MIPS 2023 Data Submission

CMS has extended the data submission period for the Merit-based Incentive Payment System (MIPS) eligible …

March 16, 2024
Congress Passed bill for MPFS

The recent passing of a partial government funding bill by Congress on March 8 is important …

March 13, 2024
Change to Processing for Telehealth Services Billed with POS 10

In calendar year (CY) 2024, the Centers for Medicare & Medicaid Services (CMS) issued a …

February 23, 2024
Diabetes Cost Measure Misattributed to Ophthalmologists

The American Society of Cataract and Refractive Surgery (ASCRS), the American Society of Retina Specialists …

October 13, 2023
Review Your 2022 MIPS Performance Feedback and Final Scores

The Centers for Medicare & Medicaid Services (CMS) has released the Merit-Based Incentive Payment System …

August 18, 2023
Clearing up confusion with refractions – Ophthalmic Professional

One of the most performed ophthalmic diagnostic tests is the refraction. Some level of refractometry …

July 1, 2023
Coding the Aborted MIGS – Ophthalmology Management

With the increased utilization of minimally invasive glaucoma surgery (MIGS) surgery in combination with cataract …

July 1, 2023
JZ Modifier Required July 1, 2023

The much-anticipated mandatory reporting of the JZ modifier for Part B Medicare begins July 1, …

June 26, 2023
Steering Clear of Kickbacks – Review of Ophthalmology

Running afoul of laws regarding self-referrals and anti-kickbacks can result in heavy fines. Here’s how …

June 10, 2023
Cigna Hits the Brakes on Their New Modifier 25 Policy

Following fierce opposition from the physician community, the insurer Cigna announced today a delay in …

May 24, 2023
Dry Eye Disease and DEWS II – Ophthalmology Management

Dry eye disease (DED) affects millions of patients worldwide and is a common reason to …

May 1, 2023
Identifying medically necessary services – Ophthalmic Professional

CMS’ recent final rule provides guidance on what is considered reasonable and …

May 1, 2023
Minor Surgery but Not Minor Documentation – Retinal Physician

To avoid payment denials, make sure your chart notes include the “how” and “why” of …

May 1, 2023
Medical Consulting Group and Corcoran Consulting Group Announce Merger

Springfield, MO, April 27th, 2023. Medical Consulting Group (MCG), a provider of consulting services to …

April 27, 2023
IHEEZO Gel gains Medicare Pass-Through

On March 13, 2023, Harrow® announced that the Centers for Medicare & Medicaid Services (CMS) …

April 24, 2023
Are Screening Tests Reimbursable? – Optometric Management

As a follow-up to last month’s article on how often an optometrist can bill diagnostic …

April 1, 2023
Medical Record Signature Options – Retinal Physician

Medicare offers multiple ways to meet the requirement. Everyone knows that medical records must be …

March 20, 2023
The Lowdown on Compounded Medications – Retinal Physician

Customization and lower costs help give these medications an essential role in patient care. Medications …

March 20, 2023
Cigna Change Modifier 25 Policy

As a result of a recent review, Cigna has announced it will require the submission …

March 20, 2023
2023 Update on Billing For Medications – Review of Ophthalmology

Injectable drugs got some new rules and regulations in the new year. Here’s what you …

March 10, 2023
How Often Can I Test for Glaucoma? – Optometric Management

A question that we receive frequently at Corcoran Consulting Group is “How often can I …

March 1, 2023
Review your documentation practices for the new year – Ophthalmic Professional

Accurate chart documentation is time consuming yet …

March 1, 2023
At Last: 2023 CMS Updates – Ophthalmology Management

There are some important changes in the Medicare program for 2023, and yet another last-minute …

March 1, 2023
Congress makes positive adjustments that affect ophthalmologists

In this Healio Video Perspective from Hawaiian Eye 2023, Kevin J. Corcoran, COE, CPC, CPMA, …

January 28, 2023
The 2023 Coding and Reimbursement Update – Review of Ophthalmology

Every year, the government tweaks the rules for reimbursement. Here’s what you need to know. …

January 10, 2023
Intravitreal Medications for Geographic Atrophy – Retinal Physician

Billing questions will arise with new drug treatment. According to the American Academy of Ophthalmology …

January 1, 2023
Update on inpatient E/M codes – Ophthalmic Professional

When circumstances present, it’s important to know the appropriate inpatient services …

January 1, 2023
Not Coded vs Not Covered – Ophthalmology Management

Many practices assume that services without regular CPT codes are automatically non-covered and payable by …

December 1, 2022
Reimbursement for Treating MIGS Complications – Glaucoma Physician

Review the Medicare rules for proper coding. Minimally invasive glaucoma surgery (MIGS) has grown rapidly …

December 1, 2022
2023 To Bring More Changes To E/M Codes – Ophthalmology Management

Remember the overwhelming changes to evaluation and management (E/M) coding for exams and most outpatient …

November 1, 2022
Coding Guidelines for Principal Care Management – Retinal Physician

Unlike some other “care management” codes that require the physician manage a patient from head …

November 1, 2022
HHS Extends Covid-19 PHE

On Thursday, October 13, the U.S. Department of Health & Human Services (HHS) Secretary Xavier …

October 18, 2022
Modifier 25 Review – Ophthalmology Management

Using modifier 25 will often get your exam claim paid — but know when to …

October 1, 2022
Reimbursement Rules for Intravitreal Injections – Retinal Physician

With audits likely on the way, it’s worthwhile to brush up. Intravitreal injections (IVIs) are …

October 1, 2022
Noridian Changes to Goniotomy LCD

Noridian has made changes to their Goniotomy coverage policy effective October 1st, 2022. It states: …

September 7, 2022
The Decision to Dilate – Retinal Physician

Some patients come to your office for an eye exam and refuse to be dilated. …

September 1, 2022
Cataract Surgery and Glaucoma Stents – Ophthalmology Management

Cataract surgery is frequently performed in conjunction with glaucoma stent procedures. In 2022, we have …

September 1, 2022
Payment for Normal Tests – Glaucoma Physician

Reimbursement for tests is based on a good rationale. Coverage for diagnostic tests is questionable, …

September 1, 2022
2021 MIPS Performance Feedback, 2021 MIPS Final Score, and 2023 MIPS Payment Adjustment Information

The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) …

August 31, 2022
Telehealth Place of Service Update

With a recent change to telehealth billing, billers need to be aware of an additional …

August 13, 2022
Extension of Telehealth Flexibility

Last week, the U.S. House of Representatives approved legislation to further extend the Medicare telehealth …

August 11, 2022
When The Irrigating Solution is a Drug – Ophthalmology Management

Since Omidria’s FDA approval in 2014, ophthalmic surgeons have been using the drug intraoperatively to …

August 1, 2022
Surprise! It’s the No Surprises Act – Retina Specialists

Beginning this year, Congress enacted Title I, known as the No Surprises Act, which falls …

July 17, 2022
The Latest On Second-Eye Cataract Surgeries – Ophthalmology Management

Reimbursement guidelines are constantly evolving. One area that is becoming more challenging is the question …

July 2, 2022
AETNA No Longer Requiring Prior Authorization for Cataract Surgery

The American Society of Cataract and Refractive Surgery (ASCRS) and American Academy of Ophthalmology (AAO) …

July 2, 2022
Your EO Coding Needs Work – Retinal Physician

Coding and documentation requirements for extended ophthalmoscopy (EO) changed in 2020. We continue to receive …

July 1, 2022
2021 MIPS Final Score Preview Now Available

The Centers for Medicare & Medicaid Services (CMS) has opened the Final Score Preview period …

June 28, 2022
Guidance for Coding Goniotomy

Summary:   Two new ophthalmic surgical products have attracted interest from surgeons:  Streamline Viscoelastic Injector® (New …

June 23, 2022
CIGNA Changes Their Modifier 25 Policy

As a result of a recent review, CIGNA will require the submission of office notes …

June 7, 2022
Beware The EO/Imaging Overlap – Ophthalmology Management

Extended ophthalmoscopy (EO; CPT 92201, 92202) and imaging of the retina (CPT 92250, 92134, 92235, …

June 1, 2022
Auditing Medical Records – Retinal Physician

With federal agencies stepping up investigations, it’s imperative that you establish a first line of …

June 1, 2022
Is Close Good Enough for CPT? – Glaucoma Physician

Unlisted codes should be a last choice. In coding, we assume “CPT” is understood. This …

June 1, 2022
Post-pandemic, Whither Telemedicine? – Review of Ophthalmology

Special coverage and payment provisions for telemedicine put into place due to the pandemic in …

May 11, 2022
How not to suffer retractions – Retina Specialists

Retinal surgery is often needed to prevent permanent vision loss. The nature of retinal disease …

May 8, 2022
Extended Ophthalmoscopy For The Comprehensive Ophthalmologist – Ophthalmology Management

Retinal specialists generally understand that extended ophthalmoscopy (EO) is above and beyond a dilated exam …

May 2, 2022
What does the future hold for billing telemedicine? – Ophthalmic Professional

If the pandemic-related rules expire, what might change? It seems like we’re almost at the …

May 1, 2022
Avoiding Audit Traps for Intravitreal Injections – Retinal Physician

Medicare pays out a lot of money for these treatments, so expect close scrutiny. Retina …

May 1, 2022
CMS Reweights Scoring for Cost Category for Groups in 2021 Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) announced on Monday, April 25th, that ALL …

April 29, 2022
IACCESS™ Trabecular Trephine – How to Code?

Summary:   Glaukos’ new product, the IACCESS™ trabecular trephine, raises interesting coding questions.  Standalone procedures should …

April 20, 2022
Streamline® Viscoelastic Injector – How to Code?

Summary:   New World Medical’s new product, the Streamline® Viscoelastic Injector, raises interesting coding questions.  Standalone …

April 20, 2022
HHS Extends the Public Health Emergency Waivers

On April 12, 2022, Secretary of Health and Human Services Xavier Becerra again renewed the …

April 19, 2022
Using data for E/M coding – Retina Specialists

It’s been just over a year since the American Medical Association released significant changes to …

April 7, 2022
The Consolidated Billing Report & Ophthalmology – Ophthalmology Management

In March 2021, Medicare sent Consolidated Billing Reports (CBR) to ophthalmologists and optometrists. The information …

April 2, 2022
Coding Changes in 2022 – Retinal Physician

Two codes see changes to their global periods, plus physician reimbursement. The year 2022 has …

April 1, 2022
CMS re-opens MIPS Hardship Exception for Groups, Virtual Groups, and APM entities

The Centers for Medicare & Medicaid Services (CMS) announced March 3 that they re-opened the …

March 24, 2022
Attention, MIGS Surgeons – Ophthalmology Management

The fastest growing treatment for glaucoma is minimally invasive glaucoma surgery (MIGS), particularly implantation of …

March 2, 2022
Glaucoma coding conundrums – Ophthalmic Professional

New codes and bundles affect your choices more than ever. You may be aware of …

March 1, 2022
New MIGS CPT Codes – Glaucoma Physician

MIGS is now a mainstream …

March 1, 2022
The Ins and Outs of Medicare’s Global Surgery Rules – Retinal Physician

The rules have been with us for decades, but questions remain. Current global surgery rules …

March 1, 2022
CPT and Medicare payment changes – Ophthalmic Professional

Ophthalmic staff need to be aware of these updates for 2022. We have some new …

February 14, 2022
Time for a financial deep dive – Retina Specialists

Whether you’re a solo practitioner or in a group practice, it’s important that you periodically …

February 11, 2022
It’s That Time Again: 2022 Coding Changes Are Here – Ophthalmology Management

The new year brings many significant changes in the Medicare program — and yet another …

February 2, 2022
HHS Extends the Public Health Emergency Waivers

On January 14, 2022, Secretary of Health and Human Services Xavier Becerra renewed the public …

February 2, 2022
Medicare: What’s New For 2022 – Review of Ophthalmology

Important changes to different levels of CPT codes, Medicare reimbursement, MIPS and rules for facilities. …

January 11, 2022
CPT and Medicare payment changes – Ophthalmic Professional

Ophthalmic staff need to be aware of these updates for 2022. We have some new …

January 2, 2022
Benign Skin Lesions: Can Your Documentation Stand Up To Scrutiny? – Ophthalmology Management

At Corcoran Consulting, we are often asked if removal of benign skin lesions is a …

January 2, 2022
Decline in Reimbursement for Diagnostic Tests – Retinal Physician

Payment reduction for multiple procedure is the likely reason when this occurs. We have long …

January 1, 2022
Revalidation CMS site goes live

The Centers for Medicare & Medicaid Services (CMS) announced that they resumed live updating of …

December 22, 2021
A Different Look at Bundled Services – Ophthalmology Management

At this time, we are all fairly well acquainted with the National Correct Coding Initiative …

December 2, 2021
Documenting IVI: Avoiding audit traps – Retina Specialists

In the course of your usual retinal clinic, you undoubtedly perform numerous intravitreal injections. Intravitreal …

December 1, 2021
CMS Makes QPP Hardship Exception for COVD-19 Automatic in Most Cases for Reporting Year 2021

The Centers for Medicare & Medicaid Services (CMS) announced that they will apply the Quality …

November 19, 2021
The Fall Updates You Need to Know About – Review of Ophthalmology

A look at the most recent updates to QPP/MIPS, CMS audits and 2022 ICD-10. This …

November 11, 2021
2022 ICD-10 updates – Ophthalmic Professional

Few codes impacting eye-care practices among this year’s changes. It’s that time of year again. …

November 2, 2021
What Counts as Test Interpretation – Retinal Physician

The why, how, and when are important. Physicians question why they must document test interpretations …

November 1, 2021
A Closer Look at Bundled Services – Retinal Physician

Don’t neglect the CPT manual, plus hints on deciphering. At this time, everyone is fairly …

October 1, 2021
CMS determines those affected by Hurricane Ida are not required to submit 2021 MIPS data

The Centers for Medicare & Medicaid Services (CMS) announced last week that providers in the …

September 29, 2021
CMS Restarts Target Probe and Educate audits

The Centers for Medicare & Medicaid Services (CMS) announced in an August issue of “MLNConnects” …

September 28, 2021
A Look at 2021’s Mid-year Changes – Review of Ophthalmology

What you need to know about the Quality Payment Program and the proposed Medicare Physician …

September 11, 2021
The unique demands of QMB patients – Ophthalmology Management

Certain patients are in a special category known as “Qualified Medicare Beneficiary” (QMB) that affects …

September 2, 2021
Does a CPT code have coverage? – Ophthalmic Professional

Find out before you deliver the service. Some payers have now made it harder to …

September 2, 2021
CMS Rules for Charging for Family – Retinal Physician

Know the rules to avoid relationship issues. It is well known that Medicare prohibits charging …

September 1, 2021
Is your ‘new normal’ compliant? – Retina Specialists

As we all move toward pandemic recovery, it’s time to think about how to recover. …

August 1, 2021
What You Can Learn From Your CBR – Retinal Physician

Comparative Billing Reports are meant to be an educational tool — and a warning — …

July 1, 2021
Medicare Public Data: Know What’s Out There – Review of Ophthalmology

Learn what information Medicare’s publishing about you and your practice, and how to correct it …

June 16, 2021
Clearing up E/M ‘clarifications’ – Retina Specialists

The AMA issued new evaluation and management guidelines that can be hard to appreciate. The …

June 5, 2021
CMS Changes Scoring for Cost Category in 2020 for Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) last week announced that all eligible MIPS …

June 2, 2021
CMS Extends Sequestration through the end of Calendar Year 2021

The Centers for Medicare & Medicaid Services (CMS) announced that the moratorium on the 2% …

June 2, 2021
Qualified Medicare Beneficiary (QMB) Program

The QMB program provides Medicaid coverage of Medicare Part A and Part B premiums and …

May 8, 2021
Utilize the JW modifier – Ophthalmic Professional

How to properly code waste of drugs and when it’s appropriate The use of some …

May 2, 2021
Comparative Billing Reports

Some of you may be receiving Comparative Billing Reports (CBR) from CMS, and you are …

April 20, 2021
The 2021 E/M Data Area—Updated Already – Review of Ophthalmology

The new codes, changes and quality-of-care requirements you need to know about to be prepared …

April 16, 2021
CMS To Hold Payments Temporarily

The Centers for Medicare & Medicaid Services (CMS) today announced that they were placing a …

April 1, 2021
New E/M codes are here. Now what? – Retina Specialists

A strategy for meeting the new requirements for Evaluation and Management codes. While we were …

March 27, 2021
Medicare payments for eye exam coding – Ophthalmic Professional

Why you might choose differently this year In my last column, I briefly reviewed how …

March 2, 2021
What’s New for 2021 – Review of Ophthalmology

The new codes, changes and quality-of-care requirements you need to know about to be prepared …

February 13, 2021
CMS Makes 2019 QPP Results Available for Review before Release to Public

The Centers for Medicare & Medicaid (CMS) is making selected portions of the 2019 Quality …

February 2, 2021
HHS Extends the Public Health Emergency

Secretary of Health and Human Services, Alex Azar, extended the Public Health Emergency (PHE) declaration …

January 20, 2021
Why was your test payment cut? – Retina Specialists

Making sense of the Multiple Procedure Payment Reduction. As we continue to try to function …

December 6, 2020
CMS Revalidation Continues to be Relaxed During the Pandemic Declaration

CMS continues to have Revalidation for providers on a hold status.  On February 28, 2020 …

November 14, 2020
Untangling the web of ‘bundles – Retina Specialists

The National Correct Coding Initiative prohibits selected coding bundles, so if you must bundle, just …

October 9, 2020
Significant Changes to The ABN Are Coming – Review of Ophthalmology

Clearing up potential areas of confusion regarding Medicare’s Advance Beneficiary Notice of Noncoverage form. This …

September 10, 2020
Retina compliance conundrums – Ophthalmic Professional

Commonly occurring issues in coding and coverage require being involved. Those of us who deal …

September 2, 2020
CMS Moves the Deadline for Requirement to Begin Using New ABN

CMS recently moved the date when practices and providers are required to use the new …

August 7, 2020
HHS Extends the Public Health Emergency Waivers

On July 23, 2020, Secretary of Health and Human Services Alex Azar renewed the public …

August 4, 2020
CMS Makes New Version of ABN Available

The Centers for Medicare & Medicaid (CMS) has finally had the updated Advance Beneficiary Notice …

July 14, 2020
New Mid-Year Codes And Regulations – Review of Ophthalmology

July is here and that means some mid-year updates from Medicare take effect. Here’s what …

July 10, 2020
CMS Opens Applications for Hardship Exceptions in the Quality Payment Program (QPP)

The Centers for Medicare & Medicaid (CMS) has opened the application period for two different …

June 16, 2020
NCCI Edits Impact Canaloplasty and Goniotomy Coding on July 1, 2020

New NCCI edits go into effect on July 1, 2020, for the code combination of …

June 11, 2020
Covid-19 Use of Catastrophe/Disaster Related Modifiers (CR and DR)

CMS has issued several blanket waivers, flexibilities and modifications to existing deadlines and timetables that …

June 3, 2020
WellMed Alters Policy on Risk Discussion in Pre-authorization Requirements

This Webnews updates a news item posted on our website on May 14, 2020.  In …

June 2, 2020
Wellmed Changes Pre-authorization Requirements

As of January, 2020, Wellmed has sent notifications to providers in Florida and Texas that …

May 15, 2020
Documentation still counts – Retina Specialists

In the COVID-19 pandemic, one old rule still applies: If you didn’t write it down, …

May 14, 2020
CMS Allows Use of Eye Codes for Telemedicine During COVID-19 Emergency

On April 30, 2020, CMS noted that they were expanding the list of codes available …

May 7, 2020
Telemedicine Rules Relaxed for Pandemic – Review of Ophthalmology

Since the pandemic has been declared a national emergency, billing for remote exams is now …

May 7, 2020
Seeing our patients via telemedicine – Ophthalmic Professional

How to code these services to get paid for them during this emergency. COVID-19 and …

May 2, 2020
CMS Extending Use of “Expired” ABN Form

Recently, CMS noted that the current Advance Beneficiary Notice of Noncoverage (ABN) form, which was …

May 1, 2020
Professional Guidance on Reopening Ophthalmic Ambulatory Surgery Centers Released

Within the last few days, some states are beginning to allow re-opening of clinics and …

April 30, 2020
Noridian Medicare Made Duplicate Payments

Many medical practices have taken advantage of the CMS Accelerated and Advanced Payment Program for …

April 17, 2020
MIPS Exceptions and Cost Category weighting for 2019 reporting year clarified by CMS

Recently, CMS extended the deadline for QPP and MIPS submissions for the 2019 Performance Year …

April 11, 2020
April 1, 2020 NCCI Bundling Edits Affecting Ophthalmology

CMS’ National Correct Coding Initiative (NCCI) Edits, version 26.1, effective April 1, 2020, include new edits …

April 7, 2020
CMS Issues Guidance on Place of Service for Telemedicine Claims

In an Interim Final Rule published yesterday in a pre-publication of the Federal Register, CMS …

April 3, 2020
CMS Grants Delay in QPP Reporting for 2019 Data Submission

In a Press Release on Sunday, March 22, 2020, CMS announced that the deadline for …

March 24, 2020
CMS Asks Surgeons to Delay Non-Essential Surgeries and Treatments during COVID-19 Emergency

CMS announced in a Press Release and in separate Guidance that “all elective surgeries, non-essential …

March 21, 2020
CMS Relaxes Some HIPAA Concerns in the Time of COVID-19

As the use of telehealth expands to accommodate both patients and providers through the COVID-19 …

March 20, 2020
Telehealth and Coverage by Private Commercial Plans and Medicare Advantage (MA) Plans

Even before the COVID-19 public health emergency, CMS gave Medicare Advantage Plans (Part C Medicare) …

March 20, 2020
CMS Issues Expanded Telehealth Regulation

Over the past few days, CMS and HHS have allowed for the expanded use of …

March 19, 2020
CMS Issues “Blanket Waivers” for Expedited Credentialing during Covid-19 Public Health Emergency

CMS today issued some regulatory advice and made available a fact sheet related to credentialing …

March 17, 2020
When pre-testing is not the best exercise – Ophthalmic Professional

Consider what has the most value for patients and the practice. This month’s column topic …

March 4, 2020
Details of billing new patient exams – Retina Specialists

All physicians use evaluation and management  codes for clinical encounters. Ophthalmologists also have specific “eye …

February 15, 2020
Get up to speed on fundus photography billing – Ophthalmology Management

Fundus photography isn’t a new test, although great advances in the technology continue. Billing rules …

February 2, 2020
Tepezza™ Approval

Tepezza™ (teprotumumab-trbw) by Horizon Therapeutics was approved by the FDA on January 21, 2020. This …

January 31, 2020
CMS Publishes 2020 Payment Adjustments related to 2018 MIPS/QPP Performance

CMS recently made available the MIPS payment adjustment information for 2020.  Practices can check their …

January 19, 2020
2020 list of Designated Service Codes Subject to Stark Law

In a December, 2019, release, CMS published the codes subject to restrictions on Physician Self-Referral …

January 19, 2020
What’s new in CPT for 2020? – Ophthalmology Management

Every year, changes to CPT coding occur that affect ophthalmology, and 2020 is no exception. …

January 2, 2020
OIG Announces Concern over Bonus Payments for Chart Reviews to MA Plans

In a December 2019 report, the Office of the Inspector General (OIG) for the US …

December 28, 2019
CMS announces changes to MIPS Claims-based Quality Measures for 2020

If you are considering reporting for 2020 under the Quality Payment Program (QPP) and are …

December 27, 2019
Clients report issues with MBI Number for Medicare not matching the new card for a beneficiary

Some practices have recently reported difficulty when searching Medicare beneficiary eligibility with the new Medicare …

December 27, 2019
Get the technician visit right – Ophthalmology Management

For starters, it must be performed under your direct supervision. The reimbursement for a visual …

December 2, 2019
Coding for surgery in the postop period – Retina Specialists

Some surgical care doesn’t end in a single operation, and the patient needs additional surgery …

November 27, 2019
Medicare Administrative Contractor notes “Vulnerability” related to Cataract Surgery Documentation

On October 7, 2019, WPS, the Part B Medicare Administrator for regions J5 and J8, …

October 15, 2019
Medicare Clarifies that Prohibition on Billing Beneficiaries for “Dropless” Surgery Continues

The Centers for Medicare & Medicaid Services (CMS) clarified their previous stance that unless a …

October 12, 2019
Step therapy: Where do we stand? – Retina Specialist

Answers to questions that linger since Medicare Advantage organizations started implementation for anti-VEGF treatments. In …

October 8, 2019
Global Confusion – Retinal Physician

Billing for a procedure done during the global period of a prior procedure. Physicians and …

October 2, 2019
Skin lesions: Can your documentation stand up to scrutiny? – Ophthalmology Management

We are often asked a simple question — whether removal of benign skin lesions is …

October 2, 2019
Medicare Announces Major Changes to Pre-operative H&P and Transfer Agreement Requirements for ASCs

The Centers for Medicare & Medicaid Services (CMS) announced in a Press Release on September …

October 1, 2019
Medicare requires practices to look back further for sanctioned persons or related affiliates

Effective November 4, 2019, the Centers for Medicare & Medicaid Services (CMS) will implement its …

September 14, 2019
What’s New for MIPS in 2020? – Review of Ophthalmology

Some changes have been made to the Merit-based Incentive Payment System. Here’s what you need …

September 11, 2019
When Extended Ophthalmoscopy and Imaging Collide – Retinal Physician

Distinction must be made between additive and duplicative information. Extended ophthalmoscopy (EO; CPT 92225, 92226) …

September 2, 2019
New therapy = new code – Ophthalmology Management

New therapies always engender questions about reimbursement — and often, new codes. Dexamethasone ophthalmic insert …

September 2, 2019
Medicare to review retina services – Ophthalmic Professional

Government scrutiny of intravitreal injections appears to be increasing. This month’s coding column is about …

September 2, 2019
CMS Releases 2018 Open Payments Data to the Public

CMS recently released Open Payments Data to the public.  CMS keeps a record of payments …

August 13, 2019
MIPS 2018 Results Available to Providers

CMS recently announced that MIPS 2018 scoring is available for providers to check.  No matter …

August 13, 2019
The reimbursement angle on aniridia – Ophthalmology Management

Aniridia is a rare condition defined as the full or partial absence of the iris. …

August 2, 2019
Audits Increase as Injections Increase – Retinal Physician

Prepare for the inevitable with proper documentation. Injectable drugs for retinal disease — particularly ranibizumab …

July 2, 2019
CMS rules and family ties – Ophthalmology Management

We all know that Medicare prohibits charging for services to immediate family members, but the …

July 2, 2019
“Step” therapy – Ophthalmic Professional

How it may impact your patients and your practice It is now fairly common for …

July 2, 2019
MIPS 2017 and 2018 Data Validation Reviews to Begin in June 2019

CMS announced last week that “Data Validation” reviews will begin in June, 2019, for the …

June 25, 2019
Are You Up to Date on Extended Ophthalmoscopy? – Retinal Physician

Explore one MAC’s explanation of the requirements. From time to time, we are reminded that …

June 2, 2019
Protect your MIPS Cost score – Ophthalmology Management

A great deal has been written about CMS’ Quality Payment Program and MIPS, and we …

June 2, 2019
CMS Clarifies QMB Beneficiary Payment Advice

CMS recently sent a MLN (MedLearn Matters) article (link here) advising of a change in …

May 11, 2019
Know the details for new drugs – Ophthalmic Professional

How administration and codes match up is important to understand. New drugs become available for …

May 2, 2019
Cataract surgeons get a new code – Ophthalmology Management

New codes are always of interest, but they also present challenges. The new Category III …

May 2, 2019
The Medicare Appeals Process – Review of Ophthalmology

Appealing a claim can be daunting. Here’s how to navigate the process, should you need …

April 27, 2019
Changes to Billing for Medicare Post-cataract Eyeglasses

The Medicare Durable Medical Equipment (DME) Medicare Administrative Contractors (MAC) have issued a joint instruction …

April 17, 2019
CMS 30-day Preview for 2017 QPP provider data for the CMS Physician Compare public website

CMS announced recently that on March 28, 2019, they are allowing providers a Supplemental 30 …

April 3, 2019
The when and how of billing for a new physician – Ophthalmology Management

Adding a physician or other health-care professional (eg, physician assistant, nurse practitioner) to your practice …

April 2, 2019
Still “a thing:” Extended color vision testing – Ophthalmology Management

Extended color vision testing is not new, and clinicians continue to find it valuable. Even …

March 2, 2019
Document need for cataract surgery – Ophthalmic Professional

Claims are increasing, and it is therefore likely that scrutiny is also. Apart from intravitreal …

March 2, 2019
Medicare Administrative Contractors (MACs) begin to roll out policies for new ERG codes

Although the new ERG code changes went into effect January 1, 2019, only recently have …

February 13, 2019
CMS Announces instructions to MACs to fix incorrect 2019 MIPS adjustments to Part B drugs

As we reported on 1/31/2019 in a prior CCG Webnews (link here), some Medicare Administrative …

February 9, 2019
CMS incorrectly applying 2019 MIPS adjustments to Part B drugs

A number of practices have been seeing their 2019 MIPS payment adjustments come in in …

February 1, 2019
QPP Portal Opens for 2018 Attestations

Late last week, the portal for Quality Payment Program 2018 submissions opened.  CMS notes on …

January 10, 2019
2019 CPT Code Changes – Review of Ophthalmology

The new Current Procedural Terminology (CPT) Category I codes effective for use on January 1, …

January 8, 2019
CPT Changes for 2019 – Ophthalmic Professional

Last issue we dealt with the updates to ICD-10 for 2019. This issue it’s CPT …

January 8, 2019
Pay attention to Remittance Advice on 2019 claims related to QPP/MIPS payment adjustments

In 2019, some practices earn bonuses or received penalties based their 2017 MIPS activity – …

December 21, 2018
CMS Deadline for Hardship Exception to QPP 2018 Program Interoperability is December 31, 2018

CMS continues to emphasize that any individual QPP-eligible practitioner or those in a small group …

December 20, 2018
CMS “Physician Compare Preview Period” is Open and Extended Until January 7, 2018

CMS announced that the 30 day period for secure review (before the scheduled mid-2019 public …

December 19, 2018
2018 MIPS Disaster Relief Hardship Exemptions for Hurricanes and Wildfires posted by CMS

CMS announced last week that those providers and practices who are affected by Hurricanes Florence …

December 11, 2018
CMS Updates the 2017 MIPS Final Scores and Payment Adjustments

On September 13, 2018, CMS announced that it updated the 2017 MIPS performance feedback results.  …

September 18, 2018
CMS Announces NCD 80.11 Diagnosis Code Fix

Many of our clients encountered denials or received rejections from their claims intermediaries when trying …

August 17, 2018
2017 MIPS Final Scores and 2019 Payment Adjustments available

This week, the Centers for Medicare & Medicaid Services (CMS) announced that the final composite …

July 6, 2018
Two new CPT codes available for use on July 1, 2018

On July 1, new CPT Category III codes became available for use; two of them …

July 4, 2018
Extended Ophthalmoscopy (92225, 92226)

From time to time, we are reminded that we need continued attention to proper documentation …

May 19, 2018
CMS Offers Providers a Way to Check Status for 2018 MIPS

CMS recently made a lookup tool available for providers to check on their 2018 MIPS …

April 25, 2018
Is a 20/20 money-back guarantee covered or noncovered by Medicare? – Ocular Surgery News

Some ophthalmologists are interested in an enhanced cataract surgery package with a corresponding added charge …

April 21, 2018
CMS Open Payments Data for 2017 Available for Provider Review

CMS recently made available the Open Payments Data for 2017 so that providers can review …

April 10, 2018
Some Quality Measures reporting has changed for 2018 reporting in Year 2 MIPS

Recently, we became aware of a few differences in the Quality reporting codes for Year …

March 13, 2018
Refractive cataract surgery coverage – Ophthalmology Professional

Ensure that your patients know what’s covered — and what isn’t. In most situations, coding …

March 2, 2018
Qualified Medicare Beneficiaries (QMB) claims processing update from CMS

Recently, the Centers for Medicare & Medicaid Services (CMS) announced they would re-introduce the QMB …

February 21, 2018
What’s New in the 2018 Medicare Update? – Review of Ophthalmology

There are a number of changes to Medicare that practices should know about. This month, …

February 10, 2018
Medicare Provider Revalidation

Be On the Lookout! Medicare requires that you revalidate enrollment for each provider every 5 …

February 3, 2018
Update: Anthem BCBS announces modifier 25 payment reduction “stay”

In October, 2017, Anthem BCBS notified providers in their monthly newsletter that they would reduce …

February 1, 2018
Update: AAO announces that CMS will fix NCD 80.11 Vitrectomy coverage denials

In October 2017, the Centers for Medicare & Medicaid Services (CMS) eliminated a large number …

January 12, 2018
Update: CMS Announces Extension to 12/01/2017 for the 2016 “Physician Compare” Data

The Centers for Medicare & Medicaid Services (CMS) announced that the preview period to review …

November 8, 2017
CMS Announces the 2018 Virtual Groups election period under MIPS is open

CMS announced recently that the “Virtual Groups” option put forth in the original MIPS/MACRA legislation …

November 1, 2017
What’s an SMRC and Why Should I Care?

A quick look at the SMRC, and how to ensure claims payment. This article addresses …

October 10, 2017
CMS Updates “Amount in Controversy” Threshold Amount for Administrative Law Judge and Judicial Review for CY 2018

On September 29, 2017, CMS updated the Calendar Year 2018 “Amount in Controversy” thresholds for …

October 4, 2017
CMS Releases newest Quality Resource and Use Reports (QRUR) & Value Modifier (VM) Information

The Centers for Medicare & Medicaid Services (CMS) released information on the 2016 Quality Resource …

September 21, 2017
CMS slightly alters stance on unbundling same-day Blepharoplasty and Blepharoptosis Surgery

The Centers for Medicare & Medicaid (CMS), in a MLN Matters article dated August 25, …

September 6, 2017
Chart requests by payers – Ophthalmic Professional

Who is looking and why? Certainly, the notion of getting a request for a moderate …

September 2, 2017
New Equipment Just Arrived! Now What? – Administrative Eyecare

Two of your provider-owners just came back from a professional society meeting they attended for …

September 2, 2017
CMS Opens Hardship Exemptions for MIPS 2017

The Centers for Medicare & Medicaid (CMS) opened the hardship application process for 2017 MIPS …

August 17, 2017
CMS Proposes Changes to Potential Penalties for 2016 PQRS and VBPM

Late on Friday, July 14, 2017, CMS released the Proposed 2018 Medicare Physician Fee Schedule …

July 19, 2017
CMS Proposed Rule for QPP Year 2

On June 20th, CMS released its proposed rule on Year 2 of the new QPP …

July 8, 2017
Orders for Diagnostic Testing – Ophthalmic Professional

Here’s a fairly common scenario for technicians: Mrs. Jones, a patient, has complaints of decreased …

July 2, 2017
Multi-use Eye Drops in the ASC

A review of dissenting opinions and prevailing …

June 29, 2017
CMS makes changes to Locum Tenens Terminology

In their MLN Matters MM10090 dated May 12, 2017, CMS revealed changes to payment policies …

May 26, 2017
CMS Establishes Tool to Check MIPS eligibility

Many practices and providers recently received notices from the Centers for Medicare & Medicaid Services …

May 17, 2017
When appealing coverage decisions – Ophthalmic Professional

Someone in your billing staff approaches you with a letter from one of your most …

May 2, 2017
Blue Cross Idaho (Medicare Advantage) Announces Requirement for Modifier CG use with Organizational Determinations

If you provide services to Medicare Advantage Plan (MA) patients that might not be covered …

April 29, 2017
NGS Announces Prepayment Audits of Exam Code CPT 99214

On April 17, 2017, National Governmental Services (NGS), the Medicare Administrative Contractor (MAC) for Jurisdiction …

April 25, 2017
ICD-10 Updates for October 1, 2017

On April 14, 2017, CMS published proposed changes to ICD-10 for October 1, 2017, along …

April 19, 2017
ABN Update

CMS published a new Advance Beneficiary Notice of Noncoverage (ABN) effective June 21, 2017. The …

April 6, 2017
CMS announces that eServices Portal Users must soon move to Multi-Factor Authentication due to Increased Security Requirements

The Centers for Medicare & Medicaid Services (CMS) recently announced that Multi-Factor Authentication (also referred …

March 23, 2017
Coding for Minimally Invasive Glaucoma Surgery

To examine long-term trends within glaucoma surgery, the Corcoran Consulting Group has tracked paid claims …

March 9, 2017
PQRS Submission Deadline Extended Again

CMS has extended the deadline for PQRS data submission by registry to March 31, 2017. …

March 7, 2017
Can a CPT code be temporary? – Ophthalmic Professional

I need to thank a reader of the column for the subject of this article. …

March 2, 2017
Fee Schedule Error Correction

As we reported at the end of January, there was an error in the 2017 …

February 24, 2017
PQRS and MU Submission Deadlines Extended

Are you scrambling to get all of your PQRS data to your registry for submission?  …

February 9, 2017
MACRA, MIPS started Jan. 1

Here is what you need to know, acronym by acronym … In 2017, CMS will …

February 7, 2017
Claim Processing of Biometry

Is your Medicare contractor denying claims for the interpretation of the second biometry, 76519-26 or …

January 28, 2017
Data Collection on Global Surgery

MACRA, Section 1848(c)(8)(B), required collection of data to value global surgical packages including the number …

January 24, 2017
ICD-10 and PQRS 2016

The revision of numerous ICD-10 codes on October 1, 2016, created issues for reporting PQRS …

December 20, 2016
CMS announces New Taxonomy Codes for Retina Subspecialty Ophthalmologists

Recently, the American Society of Retina Specialists (ASRS) announced that “after years of advocacy,” the …

November 24, 2016
CMS announces 2017 Part B Premiums and Deductibles

In a press release on November 10, 2016, the Centers for Medicaid & Medicare Services …

November 12, 2016
RAC Contracts

Recovery Auditor activity has been quiet of late.  CMS’ Contracts with the vendors were extended …

November 3, 2016
Documenting punctal plugs – Ophthalmic Professional

Your doctor sees an established patient with severe dry eye who has not been on …

November 2, 2016
ICD-10 Updates – Review of Ophthalmology

An overview of the recent updates for ICD-10, covering coding for wet and dry AMD …

October 6, 2016
ICD-10 Update and Claims

As previously discussed in various news items on our website and during our ICD-10 webinars, …

September 29, 2016
How to read and use Local Coverage Determinations

When trying to determine if your patient has coverage for a service under Medicare Part …

September 24, 2016
Get Ready For ICD-10 Changes

The one-year reprieve ends October 1. Here’s what you can expect and how to …

September 22, 2016
CMS clarifies Modifier JW use with drugs

As we previously noted in a prior WebNews on June 14, 2016, the Centers for …

September 7, 2016
New “Projects” by CMS Reviewer

In September 2012, CMS selected StrategicHealthSolutions, LLC as a Supplemental Medical Review Contractor (SMRC).  They …

August 20, 2016
Proposed ICD-10 Retinal Code Changes for 2017 Released – Retinal Physicians

ICD-10 annual updates resume on October 1, 2016.  The ICD-10-CM code set has a large …

August 16, 2016
Understanding HEDIS For Ophthalmology – Review of Ophthalmology

An overview of HEDIS, covering insurance plans and the role of ophthalmologists and optometrists. This …

August 6, 2016
Deadline for Revalidation of Medicare Enrollment

The next deadline for cycle two revalidations is July 31, 2016. If you are due …

July 27, 2016
ICD-10 Updates Finalized for October 1, 2016

In March, the Centers for Disease Control (CDC) released proposed ICD-10 changes for October 1, …

July 1, 2016
Diagnostic Test Challenges

In the retinal subspecialty, diagnostic testing represents a significant portion of services third-party payers reimburse. …

June 20, 2016
CMS delays widespread, mandatory adoption of Modifier JW for billing of drug wastage

The Centers for Medicare & Medicaid Services (CMS) recently issued a Transmittal that mandated use …

June 15, 2016
AAO announces that CMS will Accept Resubmitted Claims for CPTs 67228 and 65855

In a post on June 9 to members, the American Academy of Ophthalmology (AAO) announced …

June 11, 2016
How to Document and Code Lesion Removal – Review of Ophthalmology

The number, histology, location, removal method – a host of factors can come into play …

June 2, 2016
CXL wins FDA approval, so prepare to code – Ophthalmology Management

Corneal collagen cross-linking is a fairly new procedure to treat certain corneal diseases. As is …

June 2, 2016
CMS posts 2013 and 2014 ASC Quality Data

The Centers for Medicare & Medicaid Services (CMS) recently released 2013 and 2014 ASCQR (Ambulatory …

June 1, 2016
CMS posts Part C Training for Organizational Determinations, Appeals, and Grievances

The Centers for Medicare & Medicaid Services (CMS) has posted Web-Based Training (WBT) on the …

June 1, 2016
SLT / ALT Payment Indicator Fixed

On May 20, 2016, CMS released MLN Matters MM9633 detailing the July update to the …

May 28, 2016
Complex Cataract Surgery Update

In April 2015, the Comparative Billing Reports (CBRs) sent to most ophthalmologists compared the surgeon’s …

May 19, 2016
CMS Releases 2014 Payment Data

Earlier this week, CMS posted the Medicare provider utilization and payment data from 2014.  The …

May 14, 2016
CMS Limits Scope of Review on Some Redeterminations and Reconsiderations

The Centers for Medicare and Medicaid Services (CMS) issued a revision on May 9, 2016, …

May 13, 2016
Provider Enrollment Validation – Cycle 2

The Centers for Medicare and Medicaid Services (CMS) require that providers periodically revalidate their enrollment …

May 12, 2016
Medicare requires use of JW modifier for discarded drugs

Earlier this week, the Centers for Medicare and Medicaid (CMS), released guidance that the use …

May 5, 2016
PQRS Report for 2014

On April 15, 2016, CMS released the 2014 Reporting Experience for the PQRS program.  This …

May 3, 2016
When the Auditor Beckons – Ophthalmology Management

That letter has come, and it doesn’t send birthday wishes. Are your records in order? …

May 2, 2016
A rare test for glaucoma needn’t be provocative – Ophthalmology Management

These glaucoma tests are rare, but questions still arise. In case you have some, here’s …

May 2, 2016
Advance Beneficiary Notice 101 – Ophthalmic Professional

When your office performs noncovered services for Medicare beneficiaries, you need to be transparent and …

May 2, 2016
When Your Medicare Cup Runneth Over – Review of Ophthalmology

The Centers for Medicare & Medicaid Services defines an overpayment as money received, usually from …

April 6, 2016
Laser-assisted keratoplasty: Know the coding details – Ophthalmology Management

Keratoplasty, another name for corneal transplant, is commonly performed using a trephine, but it could …

April 2, 2016
Lingering Effects of ICD-10 – Administrative Eyecare

We look back a few months to the transition to ICD-10, you might be reminded …

April 1, 2016
Revalidation of Medicare Enrollment

Several years ago, CMS put a new process in place that requires all providers with …

March 30, 2016
ICD-10 Updates October 1, 2016

The Centers for Disease Control (CDC) released proposed ICD-10 changes for later this year. Unlike …

March 24, 2016
Value-based Payment Modifier 2014 Results

On Monday, March 8, CMS published the results of the Value-based Payment Modifier calculations for …

March 9, 2016
Interpret and report – Ophthalmic Professional

I am often asked, “How much is enough?” to document when a diagnostic test has …

March 2, 2016
Final Rule on Returning Overpayments

On February 11, 2016, CMS published a final rule (CMS 6037-F) requiring providers and suppliers …

February 19, 2016
What’s New in 2016: Fees, Codes and More – Review of Ophthalmology

There are no new ICD-10 codes at this time, but there are plenty of other …

February 10, 2016
Reading the glaucoma reimbursement tea leaves – Ophthalmology Management

This month we will review trends in glaucoma reimbursement — past and future — in …

February 2, 2016
Hardship for Meaningful Use

On Friday, January 22, 2016, CMS published changes to the hardship exemption process associated with …

January 26, 2016
Medicare Releases 2016 Physician Fee Schedule

Earlier this week, the Centers for Medicare & Medicaid (CMS), released the 2016 Medicare Physician …

January 14, 2016
New codes and revisions – Ophthalmic Professional

New and revised CPT and Health Care Procedure Coding System (HCPCS) codes are here, and …

January 2, 2016
2016 bulletin on fee schedules, codes – Ophthalmology Management

The new year, of course, brings changes to the coding landscape. This month, we will …

January 2, 2016
Corrections to 2016 Fee Schedule

Several Medicare Administrative Contractors (MACs) have indicated that they will hold claims from January 1 …

January 1, 2016
PQRS – New Measures Group in 2016

Many cataract surgeons have taken advantage of reporting the cataract measures group to successfully participate …

December 23, 2015
Risk Adjustment Audits For Medicare Part C – Review of Ophthalmology

Knowing what to expect from a Risk Adjustment Data Validation audit will help to prevent …

December 9, 2015
Overpaid? Send it back, and quickly – Ophthalmology Management

Recent actions by payers and law enforcement have changed the landscape regarding refunding overpayments — …

December 5, 2015
Deadline Extended for Value-Based Payment Modifier Informal Review Request

Practices of ten or more providers in 2014 were subject to the Value-Based Payment Modifier …

November 26, 2015
Deadline Extended for PQRS Informal Review Request

Did you receive a letter indicating failure with PQRS for 2014 resulting in a 2% …

November 26, 2015
2016 Medicare Deductible and Premiums

CMS published a news release November 10, 2015, announcing Medicare premiums and deductibles for 2016. …

November 13, 2015
Medicare Advantage Plans requiring Compliance and Fraud, Waste, and Abuse training

If you participate in a Medicare Advantage (MA) plan, you may have recently received information …

November 12, 2015
Noridian Announces Widespread Service-Specific Probe Review for 66984

On October 20, 2015, Noridian (the Medicare Administrative Contractor for a large number of states …

November 10, 2015
Complex cataract surgery: getting a closer look – Ophthalmology Management

The shift to ICD-10 has brought many coding-related issues into sharper focus and caused practices …

November 2, 2015
ICD-10 is here – Ophthalmic Professional

After a few years’ delay, ICD-10 arrived on Oct. 1. You finally have to (get …

November 2, 2015
NCCI edits affecting eyelid procedures

National Correct Coding Initiative (NCCI) edits are released quarterly; we recommend practices check them for …

October 23, 2015
ICD-10 Is Here: What You Need to Know Now – Review of Ophthalmology

After several years of delay, ICD-10 will be implemented on October 1, 2015. What does …

October 6, 2015
Alternative ophthalmic drug delivery systems – Ophthalmology Management

For most conditions, ophthalmic medications are administered by the patient, be they drop or ointment, …

October 2, 2015
PQRS 2014 Reports

If you successfully reported PQRS in 2014, you should have received their bonus payment in …

September 29, 2015
The once-in-awhile UBM test is uncommon no longer – Ophthalmology Management

Once an uncommon test, ultrasonic biomicroscopy has been garnering increased interest from some ophthalmologists. If …

September 2, 2015
Covering benign skin lesions – Ophthalmic Professional

I am often asked whether benign skin lesion removals are a covered service; the complicated …

September 2, 2015
CMS Continues to Clarify ICD-10 Flexibility Guidance

CMS’ initial ICD-10 flexibility guidance published July 6, 2015 has now been republished with clarifications …

August 26, 2015
When ECP is your choice – Ophthalmology Management

When glaucoma medications fail or the patient cannot tolerate them, surgeons have various surgical procedures …

August 2, 2015
2015 PQRS Interim Feedback Dashboard Reports – Claims-Based Reporting

Those who wish to check on their progress to date with 2015 PQRS can now …

July 31, 2015
CMS Clarifies ICD-10 Flexibility Guidance

On July 6, 2015, CMS published guidance granting some flexibility associated with the October 1, …

July 30, 2015
New Category III Code

CPT contains Category III Emerging Technology codes, which allow the collection of data on new …

July 22, 2015
The Medicare 2012 Physician Data Release – Review of Ophthalmology

The CMS Provider Utilization and Payment Data Public Utilization File is now open to the …

July 7, 2015
When floaters require treatment – Ophthalmology Management

Vitreous floaters can be annoying, but most do not require treatment. Let’s discuss what you …

July 2, 2015
Modifiers 25 and 57: Appropriate use – Ophthalmic Professional

Modifiers 25 and 57 are office-based CPT modifiers; they apply to claims when an office …

July 2, 2015
July 1, 2015 Fee Schedule Change

Although a small change, Medicare fee schedules increase slightly on July 1, 2015.  The “Medicare …

July 1, 2015
Compound Drug Code

Claim filing for compounded drugs presents numerous challenges. Different payers may require different codes for …

June 12, 2015
Hardship Exemption for 2016 Meaningful Use Adjustment

Did you attest to Meaningful Use (MU) in 2014? If not, you will be subject …

May 12, 2015
How to Navigate a CMS audit – Ophthalmic Professional

In July 2011, the Centers for Medicare and Medicaid Services (CMS) introduced a Fraud Prevention …

May 2, 2015
Should I code for OCT or fundus photography? – Ophthalmic Professional

Along with local and national payer guidelines, we think of CPT (Current Procedural Terminology) as …

May 2, 2015
Getting compliance plans right – Ophthalmology Management

Compliance plans are optional for the time being, but don’t get too comfortable — the …

May 2, 2015
Medicare Card Revisions

When a practice seeks social security numbers from patients, they often find patients hesitant to …

April 30, 2015
2015 ICD-10 Testing Options

All Medicare Administrative Contractors (MACs) have announced the availability of ICD-10 testing. The next national …

April 20, 2015
Supporting your EO claim – Ophthalmology Management

Extended ophthalmoscopy (EO) is a helpful tool when dealing with serious posterior segment disease, as …

April 2, 2015
Need-to-Know Changes For the PQRS in 2015 – Review of Ophthalmology

Changes to the participation bonus, new ophthalmic measures and requirements that can affect future reimbursements. …

April 2, 2015
Corneal Tissue Reimbursement Update

The 2015 CPT Manual introduced new and revised codes associated with glaucoma shunts.  Historically, surgeons …

March 14, 2015
Post-surgery modifiers primer – Ophthalmic Professional

Surgical CPT modifiers, which apply to claims within a global period after an initial surgery …

March 2, 2015
Most used, misused and abused – Ophthalmology Management

Modifier 59 is commonly called the “unbundling” modifier. It is both one of the most …

March 2, 2015
PQRS Cataract Measures Group

Are you planning to report the Cataract Measures Group to satisfy your PQRS reporting in …

February 24, 2015
PQRS Appeal Deadline for 2013 Reporting

Are you being penalized in 2015 for failure to succeed with PQRS reporting in 2013?  …

February 6, 2015
2015 Brings New Codes, Fee Schedule Changes – Review of Ophthalmology

Regulatory issues and reimbursement rates are only some of the things to know about in …

February 2, 2015
Glaucoma coding: 2015 brings changes – Ophthalmology Management

This month, I will tackle what practices face in the new year with regard to …

February 2, 2015
Illuminating truths to autofluorescence testing – Ophthalmology Management

Coding for fundus autofluorescence testing seems to cause widespread confusion, so this month we make …

February 2, 2015
Hospital outpatient departments, ASCs eligible for separate reimbursement for Omidria – Ocular Surgery News

On May 30, 2014, the U.S. Food and Drug Administration approved Omidria. It is used …

January 11, 2015
How to code those complicated cataract surgeries – Ophthalmology Management

Cataract surgery is one of the most highly successful treatments in all medical history, with …

January 2, 2015
Ring in the old, the new — and the reduced – Ophthalmology Management

Ophthalmology practices survived 2014, although the year had its challenges. The administrative burdens of PQRS …

January 2, 2015
Femtosecond laser coding – Ophthalmic Professional

In part two of our look into billing and coding for femtosecond laser cataract surgery, …

January 2, 2015
2015 Medicare Claims to be Placed on Temporary Hold

All Medicare Administrative Contractors (MAC) have removed the originally-posted 2015 Calendar Year (CY) Medicare fee …

December 31, 2014
Corrections to 2015 Fee Schedule

Several Medicare Administrative Contractors (MACs) have removed the 2015 Medicare Physician Fee Schedule (MPFS) from …

December 24, 2014
“Dropless” Cataract Surgery & Corneal Tissue – CMS clarification

On December 12, 2014, CMS released the January 2015 update to payment policies in the …

December 20, 2014
Payment considerations for dropless cataract surgery – Ophthalmology Management

In May, the author of an article in Ophthalmology Management quoted a physician as saying …

December 2, 2014
The Benefits of Scribes for Your Practice – Review of Ophthalmology

With some practice and a few EMR considerations, scribes can help increase both productivity and …

December 2, 2014
Fundus coding stays the same, despite technology – Ophthalmology Management

New technologies have reopened an old discussion about how practices should code fundus images taken …

December 2, 2014
ABN forms for Advantage Plans

As we reported in a news item in June, CMS’ letter dated May 5, 2014, …

November 21, 2014
PQRS 2015 Penalties

CMS began notifying providers who will be subject to the 1.5% PQRS penalty in 2015.  …

November 18, 2014
ASC Quality Reporting Results

Ambulatory Surgery Centers began participating in the ASC Quality Reporting Program in October 2012.  Last …

November 17, 2014
Laser cataract coding and billing – Ophthalmic Professional

The process of coding and obtaining proper reimbursement for laser cataract surgery is complex enough …

November 2, 2014
Compliance Programs: What Are They? – Review of Ophthalmology

Optional for now, compliance programs are a part of the ACA. Here are steps to …

November 2, 2014
Getting H&P right – Ophthalmology Management

Though a history and physical (H&P) is frequently performed, many practices come to us with …

November 2, 2014
e-Rx Incentive Payments for 2013

Did you participate in the e-Rx incentive program in 2013? If so, incentive program payments …

October 30, 2014
Value-based Modifier (Adjustment)

Is your group comprised of 10 or more providers? If so, your group will be …

October 28, 2014
2015 Medicare Deductible and Premiums

CMS published a news release October 9, 2014 announcing Medicare premiums and deductibles for 2015.  …

October 15, 2014
CMS Announces Re-Opening of Submission Period for Hardship Exception

CMS announced today that they were re-opening the period in which those wishing to apply …

October 8, 2014
Your guide to correct YAG coding – Ophthalmology Management

Questions about Medicare rules for YAG laser capsulotomy (CPT 66821) still come up. Here are …

October 2, 2014
PQRS Interim Reports

Are your submissions of PQRS measure codes being captured so that you will not face …

September 26, 2014
CMS Asks Providers and Facilities to “End-to-End Test” ICD-10 Claims

On September 19, 2014, CMS and the Common Electronic Data Interchange (CEDI) organization announced that …

September 24, 2014
CMS Announces Finalized Rule on 2014 EHR Flexibility for Meaningful Use Attestation

On Friday, August 29, 2014, CMS announced that the proposed rule allowing flexibility for providers …

September 3, 2014
Master history of present illness documentation – Ophthalmology Management

It’s just as important for you to document the history of present illness (HPI) as …

September 2, 2014
Documentation for “Second” Eye Surgeries – Ophthalmic Professional

Most of us know how to properly document the functional complaints that justify the medical …

September 2, 2014
Open Payments System Reopens

In June 2014, physicians began preparing for the implementation of the Sunshine Act. One of …

August 20, 2014
ICD-10 Update

On July 31, 2014, CMS reported that the final rule for compliance with ICD-10 had …

August 5, 2014
A Delay for ICD-10 – Now What? – Review of Ophthalmology

A one-year delay in ICD-10 implementation brings up many questions for doctors and health-care organizations. …

August 2, 2014
The ABCs of VEP – Ophthalmology Management

Here’s a look at the coding intricacies of visual evoked potential testing. This article answers …

August 2, 2014
CMS makes Interim PQRS Feedback Data Available

CMS announced that those providers who are using claims-based PQRS reporting in 2014 can now …

July 22, 2014
Coding for visual field level – Ophthalmic Professional

Use this guide to determine which VF code is most appropriate. Visual fields (VF) are …

July 2, 2014
Reimbursement for OCT screening – Ophthalmology Management

Many practices are considering using OCT for screening. What do you need to know? This …

July 2, 2014
New Category III Codes for 2014

CPT contains Category III Emerging Technology codes which allow the collection of data on new …

June 28, 2014
Sunshine Act Preparations

The Physician Payments Sunshine Act requires manufacturers of drugs, medical devices and biologicals that participate …

June 26, 2014
Medicare Advantage Plans May Not Use ABN Forms

CMS recently notified Medicare Advantage (MA) plans of improper uses of the Advance Beneficiary Notice …

June 17, 2014
OIG Report on E/M Services

On May 29, 2014, the Office of Inspector General (OIG) released a detailed report on …

June 3, 2014
Consider This Before Joining an ACO – Review of Ophthalmology

Patients and providers can both benefit under a Shared Savings Program alternative to the standard …

June 2, 2014
The vision vs. medical conundrum – Ophthalmology Management

Patients, as well as staff, are often confused about whether an exam qualifies as a …

June 2, 2014
CMS Announces Partial Freeze for ICD-10 and No New Updates for 2015

CMS published information on a code set “partial freeze” for ICD-10 in a recent posting. …

May 23, 2014
NCCI Bundling Edit Delayed

The NCCI bundle of 92012, intermediate eye exam, and 92014, comprehensive eye exam, with intravitreal …

May 20, 2014
ICD-10 Update

The inclusion of yet another delay to the implementation of ICD-10 in the H. R. …

May 5, 2014
Managing Vision Plans vs. Medical Plans – Administrative Eyecare

In the last several years, there seems to be an increased number of insurance options …

May 2, 2014
Conjunctivochalasis coding primer – Ophthalmology Management

With baby boomers entering their senior years, it’s likely you will be seeing more of …

May 2, 2014
CMS Reinstates NCCI Edits to CPT 92012 and 92014

CMS has decided to reinstate the NCCI edits to CPT codes 92012 and 92014. Specifically, …

April 12, 2014
Medicare Releases Physician Payments

In an unprecedented move, as of April 9, 2014, CMS has publicly released the records …

April 10, 2014
Cataract Quality Measure Implementation Delayed

On Wednesday, April 2, 2014, CMS announced a delay in implementation of the Quality Measure …

April 4, 2014
2014 Physician Quality Reporting System – Review of Ophthalmology

National Quality Domains, Qualified Clinical Data Registry options and other changes you should know about. …

April 2, 2014
Premium IOL cases, co-management and coding – Ophthalmology Management

Co-management of premium IOL cataract cases continues to raise questions. Here are some you may …

April 2, 2014
CMS Publishes April Update to Medicare Physician Fee Schedule

CMS announced in their MedLearn Matters MM8664 a revision to the Medicare Physician Fee Schedule …

March 26, 2014
CMS Announces 2nd ICD-10 Testing Week

CMS plans to conduct an end-to-end testing for ICD-10 claim submission for a limited number …

March 16, 2014
RAC Changes on the Horizon

CMS ordered the Recovery Audit Contractors (RACs) to conclude all additional records requests as of …

March 3, 2014
That which cannot be delegated – Ophthalmology Management

Ophthalmologists want and need to be as efficient with their time as possible, but some …

March 2, 2014
Knowing Astigmatism Codes – Ophthalmic Professional

Learn when and how to code for the diagnosis and correction of this condition that …

March 2, 2014
AAPC Certifies All Corcoran Consulting Group’s Auditors

SAN BERNARDINO, California, February 28, 2014 – Following a rigorous examination on all aspects of …

March 1, 2014
ICD-10 Test Claims Week

CMS has announced that there will be an opportunity to test claims submission with ICD-10 …

February 12, 2014
A New Year Brings New Code Changes – Review of Ophthalmology

An overview of the new ophthalmic CPT code changes, as well as changes to facility …

February 2, 2014
When a RAC audit happens to you – Ophthalmology Management

RAC audits have been occurring more frequently lately. Here are some hints to help if …

February 2, 2014
HIPAA Security Violation

Security risk analysis continues to grow in importance as it relates to safeguarding PHI (protected …

January 25, 2014
Drug Reimbursement – Mitosol

Mitosol® (mitomycin for solution) is an antimetabolite indicated as an adjunct to ab externo glaucoma …

January 8, 2014
Documentation and Coding Challenges with EHR – Administrative Eyecare

The American Recovery and Reinvestment Act (ARRA) of 2009 authorized the Center for Medicare and …

January 2, 2014
Coding for Dry Eye and Epiphora – Ophthalmic Professional

Insurance won’t cover all tear function testing. Familiarity with specific payer policies is vital to …

January 2, 2014
New Year’s coding to know – Ophthalmology Management

Welcome to the new year! You’ll find a number of code changes pertinent to ophthalmology …

January 2, 2014
Physician Fee Schedule “Fix” through March 2014

President Obama signed the Pathway for SGR Reform Act of 2013 on December 26 preventing the …

December 28, 2013
Understanding NCCI Edits and Bundles – Review of Ophthalmology

For proper reimbursement, it’s necessary to know which codes cannot be submitted together and how …

December 2, 2013
Modifier -25 – The Debate Continues – Administrative Eyecare

The appropriate use of modifier 25 with an office visit at the same encounter as …

December 2, 2013
The monovision option in cataract surgery – Ophthalmology Management

With the increased acceptance of cataract surgery with premium IOLs comes a renewed interest in …

December 2, 2013
ICD-10 Testing with Medicare MACs

It appears that CMS has had a change of heart regarding testing your ability to …

November 15, 2013
Countdown to ICD-10

As the deadline for ICD-10 approaches on October 1, 2014, following these ten steps can …

November 12, 2013
Refractions: Questions on the most common test – Ophthalmology Management

Refraction is the single most common diagnostic test in eye care. Still, questions arise about …

November 2, 2013
2014 Payment Rules Delayed

You will need to wait a bit longer this year than in years past to …

November 1, 2013
Reimbursement Issues with Lasering Floaters – Review of Ophthalmology

Most vitreous floaters do not require treatment, but for those that do, knowing the appropriate …

October 2, 2013
Meibomian gland disease and reimbursement – Ophthalmology Management

Treatment of meibomian gland dysfunction (MGD) is garnering increased interest, but you need to consider …

October 2, 2013
ICD-10 Update

The Centers for Medicare and Medicaid Services (CMS) continues to publish important information relating to …

September 23, 2013
Denied Claims Set for Reprocessing

The NCCI edits effective July 1, 2013, which bundled most exams with minor and major …

September 23, 2013
Model Privacy Notice for Physician Practice

Today the government released model notices of privacy practices (NPP) that medical practices can use …

September 18, 2013
What should you do with an overpayment? – Ophthalmology Management

An overpayment is money you should not have received, usually from a third-party payer, based …

September 2, 2013
Medications Associated with Intravitreal Injections – Ophthalmic Professional

The most common ophthalmic procedure in Medicare is intravitreal injection (CPT code 67028). The injection …

September 2, 2013
NCCI Edit Change

The American Society of Cataract and Refractive Surgeons (ASCRS) and the American Academy of Ophthalmology …

August 26, 2013
Update on Medicare and Incarcerated Patients

Medicare has been investigating and recovering payments for prior claims regarding patients who were incarcerated …

August 15, 2013
Practice forgoes audits and training, fined $14.5 million

A Washington practice was exposed by a whistle-blower for allowing its doctors to do their …

August 10, 2013
HPSA Overpayments in California

The Omnibus Budget Reconciliation Act (OBRA) of 1987 provided incentive payments to physicians who furnish …

August 3, 2013
NHIC – Changes to Customer Service Telephone Lines

NHIC, Medicare contractor for several northeast states, has added automation to the Identity Proofing for …

August 3, 2013
Essentials of Diagnostic Test Documentation – Review of Ophthalmology

Diagnostic tests beyond eye exams: what constitutes an order; the difference between interpretation and report; …

August 2, 2013
Audits and modifier 25 – Ophthalmology Management

The use of modifier 25 to be paid for an exam on the day of …

August 2, 2013
Reporting on ASC Quality Measures 6 & 7

If you have not yet reported on ASC Quality Measures 6 & 7, there is …

July 23, 2013
New Issue for RACs – Blepharoplasty

During the month of June, all four Recovery Audit Contractors (RACs) added a new issue …

July 9, 2013
CMS reports some claims are appearing without N365 Remark Code

Medicare claims use remark code N365 to indicate that your PQRS and E-Rx submissions have …

July 3, 2013
Operative Notes for Intravitreal Injections – Ophthalmic Professional

Proper operative note documents for minor retinal procedures—specifically, intravitreal injections, are necessary. Once the need …

July 2, 2013
Testing: Color Vision – Ophthalmology Management

Color vision testing examines the ability to distinguish between colors, most commonly red/green but other …

July 2, 2013
Medicare Physician Fee Schedule Update

CMS transmittal R2708CP released May 17, 2013, provides notification of the July update to the …

June 11, 2013
New Category III Codes

CPT contains Category III emerging technology codes which allow the collection of data on new …

June 4, 2013
Unanticipated Issues Implementing EHRs – Review of Ophthalmology

A new survey suggests that electronic health records can affect productivity and introduce new errors …

June 2, 2013
Adding a scribe to your practice? – Ophthalmology Management

Increasingly a part of medical practices, a scribe is a technician or medical assistant who …

June 2, 2013
Medicare Re-valuing Vitrectomy Codes

CMS previously conducted a survey of cataract surgery costs, and the result was a significant …

May 31, 2013
2013 New CPT Category III Codes

CPT contains Category III, emerging technology, codes which allow the collection of data on new …

May 15, 2013
e-Rx Hardship Exemptions 2013 Update

Don’t get caught by a 2% payment reduction in 2014 because you didn’t comply with …

May 7, 2013
Learning from “History” – Ophthalmic Professional

Patient history can be essential to coding choices. This issue’s column deals with history of …

May 2, 2013
Testing for Tear Osmolarity? – Ophthalmology Management

Increasing recognition of dry eye disease means increasing use of laboratory tests to diagnose it. …

May 2, 2013
Identifying Charting And Coding Risks – Review of Ophthalmology

Considerations to keep in mind as practices face continued charting and documentation scrutiny from government …

May 1, 2013
Medically Unlikely Edits Problem

We have become aware of claim denials beginning with dates of service on April 1, …

April 26, 2013
Guidance on Use of Scribes

Over the last few years, several Medicare Administrative Contractors (MACs) have published information regarding medical …

April 17, 2013
Payers Focusing on Second Cataract Surgery Documentation

Corcoran Consulting Group has become aware of increased scrutiny on the part of payers focusing …

March 27, 2013
ASC Quality Measures

Similar to physicians reporting on quality measures through the PQRS program for clinic services, ambulatory …

March 16, 2013
That Ubiquitous Phrase – Ophthalmology Management

CPT definitions of ophthalmic diagnostic tests frequently include the phrase, “with interpretation and report.” What …

March 2, 2013
EHR Attestation Deadline 2/28/13

Eligible professionals seeking the electronic health record bonus for 2012 must complete the attestation process …

February 19, 2013
EMR No Cure for Garbage In, Garbage Out – Ophthalmology Management

Electronic medical records (EMR) are being widely adopted. The federal government is encouraging this adoption …

February 2, 2013
A Look at What You Should Know in 2013 – Review of Ophthalmology

A new year brings regulatory issues and changes to diagnostic and CPT codes, reimbursements, incentives …

February 2, 2013
NCCI Policy Manual Updated

The National Correct Coding Initiative Policy Manual contains an important update in Chapter 1, General …

February 1, 2013
Palmetto GBA begins Complex Review of 99205 and 99204 Services for Ophthalmology California, Hawaii and Nevada

Palmetto GBA, the Medicare Administrative Carrier (MAC) for a number of states, announced it would …

January 22, 2013
Physicians should expect more scrutiny, quality measure discussions, code changes in 2013

U.S. physicians should expect closer oversight, particularly of intravitreal injections and electronic health records, along …

January 19, 2013
Denials for PQRS Code G8447

If you have been reporting Measure 124 with G8447 as one of your PQRS measures, …

January 10, 2013
New Year, New Coding Changes – Ophthalmology Management

Medicare reimbursement changes fast and often. Here are some changes you can expect for 2013. …

January 2, 2013
Are There Documentation Dangers Lurking in Your EMR? – Ophthalmic Professional

There’s no question that Electronic Medical Records (EMR) can be an amazing resource for your …

January 2, 2013
Novitas changes Co-management Claim Filing Instructions for Modifier -55

Novitas Solutions, Inc. (formerly known as Highmark Medicare Services) has begun asking for some slight …

December 29, 2012
First Coast (FCSO) begins 100% Prepayment Audits for 99215

First Coast Service Options (FCSO) announced on its webpage late last week that it was …

December 27, 2012
PQRS Cataract Measures Group

The 2012 Physician Quality Reporting System (PQRS) specifications recently published by CMS contain a new …

December 23, 2012
Noridian Issuing Claims Denials for Eye Surgery MAC Anesthesia

Recently, some of our Corcoran Consulting Group clients have received denials for large numbers of …

December 22, 2012
Multiple Procedure Payment Reduction

On November 1, 2012, CMS released the revisions to the Medicare Physician Fee Schedule for …

December 19, 2012
CfC Changes to Single-Use: A Review – Ophthalmology Management

CMS imposes requirements on ASCs, including a set of regulations known as the Conditions for …

December 4, 2012
The Ins and Outs of Informed Consent – Review of Ophthalmology

An effective informed consent process helps maintain good communication between the physician and patient. This …

December 2, 2012
The Recovery Audit Program – An Update – Administrative Eyecare

Ophthalmologists are not being overlooked by the recovery audit contractors (RACs). Despite hopes that these …

December 2, 2012
New E Rx Hardship Exemptions

On November 1, 2012, CMS released the revisions to the Medicare Physician Fee Schedule for …

November 29, 2012
Jerome H. Levy MD Award Given To Kevin Corcoran

During a meeting of the Outpatient Ophthalmic Surgery Society (OOSS) in Chicago, in concert with …

November 24, 2012
Mitosol gets new HCPCS code

Mitomycin is sometimes used in trabeculectomy surgery as an antimetabolite (to inhibit scar formation). It …

November 20, 2012
Revalidating Your Group PTAN with Medicare

Group revalidation requests are in the process of being delivered.  Just like physician revalidation requests, …

November 9, 2012
Coding for Laser Cataract Surgery – Ophthalmology Management

Laser cataract surgery is a hot topic these days, exciting for surgeons and patients alike.  …

November 2, 2012
In Coding, Documentation is Vital – Ophthalmic Professional

Welcome! Ophthalmic Professional is starting a new column. Each issue will feature either Patricia Kennedy …

November 2, 2012
Name Mismatch = Claim Rejection

CMS transmittal 2449 instructs Medicare Administrative Contractors (MACs) to reject claims if the name on …

November 1, 2012
E Rx Hardship Exemption

It is still possible to request a hardship exemption for electronic prescribing to negate the …

October 25, 2012
RAC E/M Code Audits

CMS recently approved a request by the Recovery Audit Contractor (RAC) for Region C, Connolly …

October 6, 2012
The Change That Keeps on Confusing – Ophthalmology Management

The American Medical Association, creator of the CPT Handbook, occasionally changes definitions in the book. …

October 2, 2012
The Fundamentals of Meaningful Use – Review of Ophthalmology

A look at Medicare requirements and incentives for becoming a “meaningful user” of electronic health …

October 2, 2012
New Definition, New Patient – Ophthalmology Management

The American Medical Association, creator of the CPT Handbook, occasionally changes definitions in the book. …

September 4, 2012
ICD-10 Implementation Delay Finalized

On Friday, August 24, 2012, the department of Health and Human Services announced that the …

August 28, 2012
ASC Quality Reporting Program Manual Released

The Centers for Medicare and Medicaid Services (CMS) recently released a new version (v. 1.0a) …

August 25, 2012
PQRS – Cataracts Measures Group

In 2012, a “Cataracts Measures Group” was added to the Physician Quality Reporting System (PQRS) …

August 7, 2012
Reimbursement Success for Premium IOLs – Ophthalmology Management

Premium IOLs, including presbyopia-correcting IOLs (PC-IOLs) and astigmatism-correcting IOLs (ACIOLs), have increased in popularity over …

August 2, 2012
New Decisions Bring Continuing Changes – Review of Ophthalmology

This mid-year update covers a variety of changes from DHHS and CMS that may affect …

August 2, 2012
Proposed Change to Electronic Prescribing (E-Rx) Exemptions for 2013

On July 6, 2012, the proposed 2013 Medicare Physician Fee Schedule policies and rates were …

July 31, 2012
CMS Begins Audits of Stage 1 Meaningful Use Attestation

According to posts widely reported by a large number of media, legal, and electronic health …

July 31, 2012
July 1, 2012 NCCI Edit Changes

The July 1, 2012 posting of the National Correct Coding Initiative (NCCI) edits reveals the …

July 6, 2012
Bandage Contact Lens Basics – Ophthalmology Management

The placement of therapeutic bandage contact lenses have undergone coding changes. I’ll review the reimbursement …

July 2, 2012
CPT Change 2012 – Administrative Eyecare

Physicians and administrators want to take advantage of all possible opportunities to increase revenue by …

July 2, 2012
Eylea (Aflibercept) gets new HCPCS supply code

In a recent public notice, the Centers for Medicare and Medicaid (CMS) noted that a …

June 30, 2012
Safe Surgery Checklist for Ambulatory Surgery Centers

This year, one of the two structural reporting measures for ASCs is a “Safe Surgery …

June 27, 2012
New CPT code for Intraocular Telescope Surgery goes into effect

Effective July 1, 2012, the Centers for Medicare and Medicaid (CMS) noted the mandatory use …

June 12, 2012
Webnews – Audit focus notes – Evaluation and Management Scorecard 101 Basics

On June 6, 2012, Novitas Solutions, a Part B Medicare Administrative Contractor hosted a webinar …

June 8, 2012
Goniopuncture Know-How – Ophthalmology Management

Glaucoma is a difficult disease to treat successfully – some treatments only work for a …

June 2, 2012
Balancing Medical and Vision Plans – Review of Ophthalmology

Managing Medicare, vision and medical plans without compromising patient care can be complicated. Here’s help. …

June 2, 2012
OIG Finds Overpayment on Modifier 25 Use

In a public notice dated May 21, 2012, by the Office of the Inspector General …

May 30, 2012
RAC Review Issue

Recovery Audit Contractors (RACs) in at least two of the four jurisdictions are reviewing claims …

May 25, 2012
New Rules – Orders for DMEPOS, clinical laboratory & imaging services

On Friday, April 27, 2012, CMS published a notice in the Federal Register detailing the …

May 5, 2012
New NPI Rule

CMS is issuing new rules and changes to enrollment requirement, as well as requirements for …

May 2, 2012
Medicare Enrollment Changes

CMS plans to make several welcome changes to the enrollment process. Part B News reports …

May 2, 2012
Telemedicine Coding Basics – Ophthalmology Management

Many people have difficulty accessing appropriate eye care because of illness or infirmity, or because …

May 2, 2012
Prepayment Reviews of Ophthalmic Tests

Ophthalmic Diagnostic Tests are to be the subject of prepayment review for Palmetto Medicare. The …

April 14, 2012
April 1, 2012 NCCI Edit Changes

The April 1, 2012, posting of the National Correct Coding Initiative (NCCI) edits takes on …

April 10, 2012
April 2, 2012 Update to Medicare Physician Fee Schedule

The CMS MLN Matters 7745 (MM7745) contains several important updates implemented on April 2, 2012. …

April 10, 2012
Over Paid?-RACs take notice

The Recovery Audit Contractors continue to find new targets for review and recoup lost dollars …

April 7, 2012
Integrating Blended Vision into a Practice – Review of Ophthalmology

How to determine the best candidates for blended vision, and answers to related Medicare CPT …

April 3, 2012
Cataract Surgery, Comanagement & CMS – Ophthalmology Management

As refractive cataract surgery becomes more popular, questions about comanagement become more frequent. Here is …

April 2, 2012
WebNews 5010 Enforcement Delayed Again

CMS Announces Extension of Enforcement Discretion Period for Updated HIPAA Transaction Standards (5010) The Centers …

March 16, 2012
E-Rx Hardship Exemptions 2012 Update

Are you seeking a hardship exemption from the E-prescribing requirement for 2013? If so, you …

March 13, 2012
Electronic Signatures and PECOS

Despite being able to complete enrollment applications on line through the internet PECOS (Provider enrollment, …

March 6, 2012
Getting to the Bottom of Asthenopia – Ophthalmology Management

If you have patients who engage in a lot of near work, you probably will …

March 2, 2012
Importance of Signature Logs

Comments from OIG in support of signature logs: The Office of the Inspector General (OIG), …

February 24, 2012
New Recoupment Options

The Centers for Medicare and Medicaid (CMS) recently issued new options for those facing recoupment …

February 21, 2012
Place of Service Clarification

Physicians and billers have long struggled with using place of service “inpatient hospital (21)” for …

February 15, 2012
Continuing Changes for CPT Codes in 2012 – Review of Ophthalmology

Highlights of change that will commonly affect ophthalmic practices this year, including additions, modifications and …

February 2, 2012
E-Rx Hardship Exemptions

Is your 2011 application for an E-Rx hardship exemption for 2012 still pending? If so, …

February 1, 2012
Electronic Prescribing Feedback Reports

Are you waiting to learn if you are exempt from the 2012 E-prescribing penalty for …

January 10, 2012
The New Year Brings New Changes – Ophthalmology Management

Medicare and reimbursement change fast and often. Let’s address some of the changes you can …

January 2, 2012
Redefinitions Increase the Use of Modifier 25 – Review of Ophthalmology

The redefinitions of some surgeries from major to minor procedures has led to an increase …

January 2, 2012
Medicare Physician Fee Schedule 2012

The Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3765) signed by President Obama …

December 31, 2011
Transition/Compliance Plans for Medicare claims via 5010:

The Centers for Medicare and Medicaid (CMS) recently issued further clarification regarding 5010 claims. They …

December 30, 2011
Information Regarding the Holding of 2012 Date-of-Service Claims

Attention Health Professionals: Information Regarding the Holding of 2012 Date-of-Service Claims for Services Paid Under …

December 20, 2011
Electronic Prescribing Adjustment for 2012

A recent Special Edition Article MLN Matters, Number SE1141, answers many of the questions raised …

December 13, 2011
Government Targets Improper Payment – Ophthalmology Management

Although not specific to healthcare, the Improper Payment Elimination and Recovery Act was signed by …

December 2, 2011