Knowledge Center

Category: Reimbursement

Anesthesia & Pain Coder’s Pink Sheet: Hartley Medical Gives Advice on CMS Billing

Be sure to check out the August 2012 – Vol. 13, Issue 8 – edition of Anesthesia & Pain Coder’s Pink Sheet. The Coder’s Pink Sheet, a newsletter brought to you by Decision Health, is the leading independent information service devoted exclusively to coding and billing anesthesia and pain services. This month’s issue features some fascinating […]

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A CMS Billing Update: Not If, But When

At the 14th Annual ASIPP meeting in Washington, D.C., June 8-10, 2012, my team had the opportunity to discuss CMS billing with one of the conference’s faculty members – a specialist on medical coding/billing and compliance. According to this source, CMS is aware of the issue where pharmacies are billing Medicare for implanted drug pump […]

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Invoice Auditing: Are You Getting What You Bargained For?

Not many of us actually know the Terms and Conditions: those novel-length agreements made between two parties before entering into a business relationship. The truth is that simple commerce is long gone; handshake deals and cocktail-napkin contracts are things of the past. Today’s business world has an endless number of suppliers across an endless number […]

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A CMS Billing Update

*** UPDATE *** I recently spoke with an individual from the International Academy of Pain Management regarding the previously discussed CMS Medicare billing issue. From this discussion, it has been suggested that CMS acknowledges that pharmacies billing Medicare for implanted drug pump medication provided “incident to” a physician service is “questionable” practice. It was also […]

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Is Change Coming? Medicare Billing for Implanted Drug Pumps

On December 15, 2011, the Centers for Medicare and Medicaid Services (CMS) issued news for Medicare Part B Providers to reflect Change Request (CR) 7397 – which clarifies policy with respect to restrictions on pharmacy billing for drugs provided “incident to” a physician service.   Pharmacies, Suppliers and Providers may not bill Medicare Part B […]

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Difficult Reimbursement Conditions

­­ The reimbursement for intrathecal drug therapy is a very complex process. I wanted to take some time to answer the question that I have been increasingly receiving, “What the heck is going on with reimbursement?” Therefore, I want to provide information regarding reimbursement issues to ensure proper payment for the treatment of your patients. […]

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Changes to Reimbursement of IT Drugs

Palmetto New Rates / unit     Drug PGBA Rate Unit Baclofen 0.0030 mcg Bupivacaine 0.0400 mg Clonidine 0.0010 mcg Fentanyl 0.0072 mcg Hydromorphone 0.1300 mg Morphine 0.0500 mg Sufentanil $0.090 mcg Droperidol 0.0013 mcg Prialt 7.9000 mcg

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