Billing for Chronic Care Management

** UPDATE FOR 2017 ** An estimated 117 million adults have one or more chronic health conditions, and one in four adults have two or more chronic health conditions. Chronic disease is prevalent among Medicare beneficiaries, with most beneficiaries having multiple chronic conditions, which increases the risk for poor health outcomes such as mortality and […]

MACRA – Final Rule

Medicare Physician Billing Services for Raleigh, NC & West Palm Beach, FL Breaking: Medicare finalizes sweeping changes to physician payments Today, the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated final rule implementing the Medicare physician payment reforms enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). With […]


The Centers for Medicare & Medicaid Services (CMS) recently published some facts about ICD-10 intended to dispel myths and address common questions about the upcoming transition: The ICD-10 transition date is October 1, 2015 – The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the […]

Medicare News!! SGR Repealed, 21% Cut Averted

On Tuesday, April 14th, the Senate voted to approve the Medicare Access and CHIP Reauthorization Act, H.R. 2. This legislation, which passed the House of Representatives on March 26, permanently repeals the Medicare Sustainable Growth Rate (SGR) formula. President Obama will sign the bill into law. In addition to SGR repeal, the law includes three […]


Excerpt from MedLearn Matters article MM9051, revised 12/31/2014, implementation date 2/2/2015 The Centers for Medicare & Medicaid Services (CMS) is updating the Medicare coverage requirements to align with the updated ACIP recommendations. Effective for dates of service on or after September 19, 2014, (and upon implementation of CR9051), Medicare will cover: An initial pneumococcal vaccine […]

CPT Changes 2013 – Carotid Angiography

The RUC Relativity Assessment Workgroup continues their mission of abandoning the component coding concept and bundling certain services into single codes based on their 75 percent rule.  For code pairs that are billed together greater than 75 percent of the time, new CPT codes are created that bundle multiple procedures into one single code.  Consolidation […]

Billing for Transcatheter Aortic Valve Replacement (TAVR)

  Background Transcatheter Aortic Valve Replacement (TAVR) is a new technology for use in treating certain patients with aortic stenosis.  As an alternative to open heart surgery, a bioprosthetic valve is inserted percutaneously using a catheter and implanted in the orifice of the native aortic valve.  Potential benefits of this procedure are that it’s less […]

Intensive Behavioral Therapy for Obesity

Did you know that Medicare now has coverage provisions for behavioral therapy for obesity? Effective with dates of service November 29, 2011 and forward, Medicare beneficiaries with obesity are eligible for a series of face-to-face visits with a primary care physician. For these services, the Medicare Part B deductible and coinsurance are waived. MedLearn Matters […]