Category: Healthcare News

Access to telehealth, greatly expanded during the pandemic, has continued via a series of temporary extensions rather than legislation. The most recent extension expired on September 30, 2025. With the current deadlock and government shutdown, the future is unclear. In short–if you couldn’t do telehealth for Medicare patients before the pandemic, you can’t do it… Continue Reading

Dear Providers, Claimpower identified an issue where Aetna is reimbursing CPT 99214 and 99215 at a down-coded rate. Under Aetna’s Claim and Code Review Program, these higher-level E/M services are downcoded due to their Evaluation and Management (E&M) Program. What’s Happening? Aetna  partnered with a third-party vendor to review E&M coding. This vendor assesses whether Level 4 and 5… Continue Reading

Get Ready for the 2024-2025 Flu Season: What You Need to Know Flu season is approaching. It is important that you remind your patients to receive their annual flu shots, especially between September and October. Vaccination Age limit Everyone aged six months and older should get a flu shot each year. Best Time: Encourage patients… Continue Reading

Understanding Incident To and Split Service Billing Across Office, Hospital, and Nursing Home Locations In the complex world of medical billing, understanding the appropriate use of “incident to” and split/shared service billing is crucial for ensuring compliance and maximizing reimbursement. These billing practices are essential for various healthcare settings, including office, hospital, and nursing home… Continue Reading

HCPCS Code G2211: Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition (add-on code, list separately in… Continue Reading

Telehealth Services After the PHE After learning that the public health emergency (PHE) for COVID-19 was to end May 11, the healthcare industry wondered what telehealth services would remain covered. What regulations under the Consolidated Appropriations Act, 2023 (CAA) would extend coverage? Which provisions in the Medicare Physician Fee Schedule Final Rule be enforced? And… Continue Reading

INCIDENT TO BILLING  The intent of this bulletin is to clarify Insurance requirements for billing “Incident To” services (services rendered by a licensed/certified professional but directed by and billed under the NPI of a supervising practitioner). USING THE SA MODIFIER “Incident To” services are also relevant to services performed by auxiliary personnel working within the… Continue Reading

Why will the HRSA COVID-19 Uninsured Program stop accepting claims? The HRSA COVID-19 Uninsured Program (UIP) will soon stop accepting claims due to a lack of sufficient funds. The program will continue to accept claims for testing and treatment until 11:59 PM on March 22, 2022, and claims for vaccine administration until 11:59 PM on… Continue Reading