Pharmacy Question for the Week of June 5, 2017
MedLearn Publishing
June 5, 2017
Will Medicare pay for an injection if that’s the only reason for an office visit?
Will Medicare pay for an injection if that’s the only reason for an office visit?
What codes can be assigned to report infectious agent molecular diagnostic testing using nucleic acid probes?
Is there an appeal process for units of service (UOS) denied based on medically unlikely edits (MUEs)?
The recently filed federal whistleblower lawsuit alleging that tens of billions of dollars in improper payments were made to insurers by Medicare Advantage over the
The second of two recent lawsuits against Medicare Advantage Organizations (MAOs) was announced on Tuesday, when the U.S. Department of Justice reported a $32.5 million
All of the talk in the news about obstruction of justice should serve as a reminder of the importance of knowing what you can and
In news long awaited by physical therapists in private practice, the Centers for Medicare & Medicaid Services (CMS) has released guidance implementing rules for the
What is the effective date for the policy you reported in last week’s QA—the one related to reporting and charging requirements when a device is furnished without cost to the hospital etc.?
May I report MRI and MRA of the brain during the same session?
If patient has a diagnostic heart cath with intravascular ultrasound (IVUS) one day and then is taken back to have intracoronary stents deployed with IVUS the next day, can IVUS be coded at both sessions?
Are hemophilia clotting factors included in the IPPS rates for hospital inpatients?
We assign code 94375 (respiratory flow volume loop) when a preoperative evaluation is ordered to distinguish between fixed and variable upper-airway obstructions. Can you provide any billing guideline we should know?
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
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