Topics & Specialty Resources

In a report, the Office of the Inspector General found that Medicare improperly paid for catheters and kits. To avoid improper payments, review the Urological Supplies provider compliance tip for more information.

It finally happened! The Centers for Medicare & Medicaid Services (CMS) finally released the 2026 Outpatient Prospective Payment Final Rule on Friday at 4:15 pm, delaying my Friday night dinner out with my wife by several hours. And the final rule really had no surprises. Of course I went...

Workers’ compensation (WC) fees are the reimbursement rates established for medical services provided to employees who suffer work-related injuries or illnesses. Learn more about the fees shown in Find-A-Code.

This week, as we continue to explore querying for acute (metabolic or toxic) encephalopathy, I want to examine the Glasgow Coma Scale (GCS) as a clinical indicator for encephalopathy. I know many consultants encourage this approach, but I hope to convince you that this is an outdated practice, and...

The Center for Medicare & Medicaid Services (CMS) has made some significant changes to their Evaluation & Management Services Booklet. The following portions of the booklet have been changed to address new and revised policies:

Find-A-Code uses Usual, Customary, and Reasonable (UCR) fees as established by the Veterans Administration (VA) to help determine the amount paid for inpatient medical services based on the diagnosis and the geographic area. This article addresses information and pricing for facility fees based on Diagnosis Related Groups (DRGs). The UCR rates included in FindAcode.com come directly from the VA and are divided up into varying per diem (daily) rates as defined by the VA. Be aware that different payers may have different payment methodologies as defined by individual contracts

The Office of Inspector General (OIG) recently released a report entitled “Billing for Remote Patient Monitoring in Medicare Analyzing Medical Practices’ Billing Patterns”. Remote physiologic monitoring services (codes 99091, 99453, 99454, 99457, and 99458) were carefully reviewed because of the significant increase from 2023 to 2024 in the number of patients receiving these services (27% increase) as well as a 31% payment increase during the same time period.

RADs with bi-level capability, with or without a backup rate feature, are devices that use a noninvasive interface (mask) to deliver a higher level of airway pressure when the patient inhales compared to when they exhale. A backup rate feature enables the device to provide a prespecified respiratory rate if the patient’s spontaneous respiratory rate decreases below a set number. HMVs deliver a predetermined amount of air with each breath and typically have more monitoring, safety, alarm, and backup power features (such as batteries) than RADs.

In February 2024, HHS published a final rule modifying the Part 2 regulations to implement section 3221 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to increase coordination among providers treating patients for SUDs, strengthen confidentiality protections through civil enforcement, align certain Part 2 requirements with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach Notification Rules, and enhance integration of behavioral health information with other medical records to improve patient health outcomes. The final rule provides the public with the ability to file complaints alleging violations of the Part 2 confidentiality provisions, requires Part 2 programs to provide notification of breaches of Part 2 records, and implements in regulation HHS’s civil enforcement authority, including the potential for civil money penalties for violations of Part 2.

Medicare Part B payments for “incident-to” services are once again under scrutiny by the HHS Office of Inspector General (OIG) who has flagged “incident-to” billing (when services by non-physician personnel are billed under a physician's NPI at full physician rate) as high risk for improper payments and program abuse.