News

Author finds fault with WPS policy. You might think that you could rely on the accuracy of a Medicare Administrative Contractor (MAC) policy, but apparently, you can’t.  First, I’d like to extend thanks to my colleague Sharon for sending me WPS’s deeply flawed split/shared evaluation and management (E&M) policy. If…
President Trump issues an executive order on kidney disease and a new payment model for radiation therapy. As reported by Dr. Ronald Hirsch on the RACmonitor.com Monitor Mondays webcast, last week the president issued an executive order on kidney disease. The executive order was touted by many in the medical…
An interview with a subject matter expert sheds light on one of healthcare’s trendiest topics. Editor’s Note: Ellen Fink-Samnick is a member of the RACmonitor editorial board and a permanent panelist on Monitor Mondays whose areas of expertise include the social determinants of health (SDoH). Chuck Buck recently conducted an online interview with…
Hot topics come and go – and healthcare is no exception. A few years ago, predictive analytics (PA) was making its rounds, and I remember seeing several vendors at a few national healthcare conferences touting their use of this advanced statistical technique. In fact, at one conference, a backdrop used…
Coverage would include those suffering from chronic lower back pain who are also enrolled in approved studies. The Centers for Medicare & Medicaid Services (CMS) is proposing to cover acupuncture for Medicare patients who suffer from chronic lower back pain and are also enrolled participants in certain clinical trials –…
Swing vote by Chief Justice John Roberts reflects his support of judicial precedent. On June 26 the U.S. Supreme Court issued a decision (https://www.supremecourt.gov/opinions/18pdf/18-15_9p6b.pdf)  on how courts should handle ambiguous government regulations.  Many people, including me, expected that the case would change the level of deference courts grant to a…
Coding Guidelines and Conventions trump Coding Clinic. Hats off to coders.  This group of medical information professionals is required to master one of the most convoluted and confusing set of rules known to civilized man in order to categorize hospital services and submit their findings to insurance companies for billing.…
Case is centered around Level 2 and Level 3 E&M encounters. This past week, I received a call from an older physician who has been in practice for 46 years; for privacy purposes, we will refer to him in this piece as Dr. Purple. Before I tell you his story,…