Medicare epidural LCD concern
Question for the group. Here is section 5 of the new medicare LCD
5. It is considered medically reasonable and necessary to perform TFESIs bilaterally only when clinically indicated.
Repeat ESI when the first injection directly and significantly provided improvement of the condition being
treated may be considered medically reasonable and necessary when the medical record documents at least
50% of sustained improvement in pain relief for at least three months and/or improvement in...
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Source: Student Doctor Network - March 16, 2022 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
Cluneal PNS
Anyone doing much cluneal PNS? Not getting any exposure to it during fellowship but recently met with our Nalu rep who talked about it.
My questions are:
- what’re the indications?
- who’s the ideal patient?
- how’s insurance coverage in non-Medicare patients?
- have you seen positive results with it? (Source: Student Doctor Network)
Source: Student Doctor Network - March 13, 2022 Category: Universities & Medical Training Authors: gaspasser127 Tags: Pain Medicine Source Type: forums
Frank Patino of UFC
Pain Doctor Convicted of Over $100 Million Health Care Fraud Scheme
A federal jury in the Eastern District of Michigan convicted a Michigan doctor today for his role in masterminding and executing a complex scheme to defraud Medicare and other health insurance programs by administering medically unnecessary spinal injections in exchange for prescriptions of high...
www.justice.gov
“According to court documents and evidence presented at trial, Francisco Patino, 66, of Wayne County, excessively prescribed highly addictive opioids to his patients a...
Source: Student Doctor Network - March 11, 2022 Category: Universities & Medical Training Authors: nimbus Tags: Anesthesiology Source Type: forums
Is Your Practice or Company Under Investigation for Providing Amniotic Injections?
Amniotic Injection Fraud? CID? What You Need to Know | Federal Lawyer
Is your healthcare practice or business under investigation for amniotic injection fraud? Our federal healthcare fraud defense lawyers explain what you need to know.
federal-lawyer.com
Now that Medicare clawbacks for the amniotic fluid injections are coming, I was curious what would happen to the people doing them and found this interesting article written by a law firm. Hope none of you got caught up in this. (Source: Student Doctor Network)
Source: Student Doctor Network - March 6, 2022 Category: Universities & Medical Training Authors: Agast Tags: Pain Medicine Source Type: forums
Minimum time to code based on MDM?
So I am doing some quick back of envelope calculations, considering making the jump into telepsych-heavy private practice accepting commercial insurance and Medicare, and I have the following question. Is there a minimum time I a required to spend "face to face" (screen to screen) with a patient if I am coding, say, a 99214 based on MDM?
Of course I know the time limits apply if you are coding based on time, but let's say hypothetically I spend 7 minutes face to face with a patient for a...
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Source: Student Doctor Network - February 6, 2022 Category: Universities & Medical Training Authors: Coriolanus Tags: Psychiatry Source Type: forums
Kypho coding
Our Medicare guidelines are stating vertebral augmentation is only for patients with known osteoporosis. With DEXA missing up to 50 percent of these cases, how are you guys showing medical necessity and demonstrating known osteoporosis? (Source: Student Doctor Network)
Source: Student Doctor Network - February 2, 2022 Category: Universities & Medical Training Authors: Vie221 Tags: Pain Medicine Source Type: forums
Amniotic membrane grafts for ulcers
So I'm looking into applying skin substitute grafts. I've studied the LCD and am talking to different companies. Of the money that Medicare pays for the graft, one company wants 70% of it. Another company wants 60% of it. I've heard of others who split it 50/50. Just curious what you guys are seeing regarding the split? Just to clarify, you bill the Q code per sq cm to Medicare, and they pay the practice a certain dollar amount per sq cm, then the practice pays the percentage agreed...
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Source: Student Doctor Network - January 27, 2022 Category: Universities & Medical Training Authors: Creflo Tags: Podiatric Residents & Physicians Source Type: forums
Finances: Cornea vs Retina
Hello everyone,
I'm a PGY2 resident right now thinking about fellowships. For me, high income potential is important; we have sacrificed years in training while our peers from high school and college are making 300K+ in tech and fintech for years; plus, our work is extremely valuable and worth a lot more than what medicare pays. Anyways, I'm thinking between cornea and retina fellowship and was wondering which would be a better financial decision in the long run.
Cornea: refractive surgery...
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Source: Student Doctor Network - January 17, 2022 Category: Universities & Medical Training Authors: PLA2 Tags: Ophthalmology: Eye Physicians & Surgeons Source Type: forums
Top 30 Complex Sim Users in America: 7 Are Derm/Fam Prac
This confirms some suspicions I had. This is 2019 data.
Medicare Provider Utilization and Payment Data: Physician and Other Supplier | CMS
The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. To navigate directly to the Physician and Other Supplier PUF, please use the...
www.cms.gov
Take
Tot_Srvcs x Avg_Mdcr_Stdzd_Amt = Total Reimbursement
from Medic...
Source: Student Doctor Network - December 30, 2021 Category: Universities & Medical Training Authors: TheWallnerus Tags: Radiation Oncology Source Type: forums
Medicare Audit
Anyone ever had this happen to them?
Medicare is conducting a 20 case review of your facet joint injections, please reviewed the LCD....."
What to expect? (Source: Student Doctor Network)
Source: Student Doctor Network - December 27, 2021 Category: Universities & Medical Training Authors: buddababa Tags: Pain Medicine Source Type: forums
Mid-level providers and AP Billing
Morning,
Over the years my partners and I have had conversations about the utility of mid-level providers in anatomic pathology. By mid-level providers we mean licensed ARNPs and Physician Assistants (PA's) ; not Pathologist's' Assistants. We don't know of any groups that do this. Right now, this is more of a thought experiment.
We usually discuss two separate scenarios:
1. Can a licensed mid-level practitioner be the rendering provider and bill Medicare and commercial payors for...
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Source: Student Doctor Network - December 17, 2021 Category: Universities & Medical Training Authors: DPath2000 Tags: Pathology Source Type: forums
Pain functionality scale
With the Medicare requirement for documentation of functionality score for RFAs, and now for epidurals, what pain functionality score are you collecting? Among the ones the Noridian LCD names, the ODI seems the shortest and simplest. However, if I interpret the language in a lawyerly way, they aren’t exactly saying you must use one of the scales listed. With that in mind, I chose the PEG scale: 3 items, one of which is pain intensity...
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Source: Student Doctor Network - December 12, 2021 Category: Universities & Medical Training Authors: callmeanesthesia Tags: Pain Medicine Source Type: forums
Anesthesia for ESI
Has anybody seen the announcement that medicare is no longer reimbursing anesthesia care for pain procedures? Commercial insurances will follow I assume?
In my area, the local pain MDs employ their own CRNAs and every patient gets snowed with propofol. The all receive large out of network anesthesia bill. (Source: Student Doctor Network)
Source: Student Doctor Network - December 10, 2021 Category: Universities & Medical Training Authors: nycitygas Tags: Anesthesiology Source Type: forums
What specialties have the least reliance on medicare or medicaid?
With reimbursements being cut every year I'm skeptical that it will improve unless something drastic and unrealistic happens such as physicians uniting to lobby to congress or the majority of physicians not accepting Medicare or Medicaid.
Which specialties deal with these insurances the least? I'm figuring ones that can delve into more cosmetic stuff like plastics and derm and specialties with a high patient variance and practice flexibility like FM. (Source: Student Doctor Network)
Source: Student Doctor Network - December 9, 2021 Category: Universities & Medical Training Authors: Proudfather94 Tags: Medical Students (DO) Source Type: forums
Medicare cuts 2022
It's that time of year.Make your voice heard and tell your friends, family, and colleagues to do so as well.
Medicare reimbursement rates for psychologists’ services will be cut 3.75% starting in January unless Congress takes action.
Take Action (Source: Student Doctor Network)
Source: Student Doctor Network - December 9, 2021 Category: Universities & Medical Training Authors: Sanman Tags: Psychology [Psy.D. / Ph.D.] Source Type: forums
