Automated Downcoding – How to Fight Back
The planned policies from Aetna and Cigna represented a significant shift from, “if it wasn’t documented it wasn’t done” to “guilty until proven innocent” – with payers automatically denying level four and five office visit codes with no review of medical record documentation. The following table summarizes the core elements of these policies based on […]
CMS Halts Medicare Claims Payments Due to Government Shutdown: Key Steps for Healthcare Providers
The Centers for Medicare & Medicaid Services (CMS) has announced a temporary pause on Medicare claims payments effective October 1, 2025, as a result of the ongoing federal government shutdown. This action is part of standard CMS contingency plans when congressional payment “extenders” lapse without renewal. Understanding the Medicare Claims Payment Delay CMS has instructed all Medicare Administrative Contractors […]
Policy Overview: Aetna CCRP & Cigna R49 (Never Published)
The planned policies from Aetna and Cigna represented a significant shift in how payers handle high-level office visits. The following table summarizes the core elements of these policies based on available information. Policy Aspect Cigna’s R49 Policy (Currently Paused) Aetna’s Claim & Code Review Program (CCRP) Effective Date Officially paused as of Oct. 1, 2025 […]
2025 Telehealth: What the End of Medicare Flexibilities Means for Your Practice
For years, Medicare telehealth rules have been defined by the temporary flexibilities established during the COVID-19 Public Health Emergency (PHE). These rules have allowed providers to care for patients in their homes, use audio-only phone calls, and bypass strict geographic limits. However, this era is coming to a definitive close. Key Medicare telehealth flexibilities for non-behavioral/mental […]
Telehealth Billing 101: A Clear Guide to CPT Codes for Non-Medicare Patients
Telehealth has become a cornerstone of modern healthcare delivery, offering flexibility for both providers and patients. However, navigating the billing rules can be a challenge. At Compass Healthcare Consulting, we help practices streamline their revenue cycle, and a key part of that is mastering telehealth reimbursement. This guide breaks down the essential billing guidance for non-Medicare […]
Lipoma Excision CPT® Codes & Reimbursement Strategies
Breaking Down Lipoma Excision CPT® Codes Selecting the right code depends on location, depth, and size of the lipoma. Here are some examples: Subcutaneous Lipomas (Above Fascia) Face/Scalp (≤2 cm) → 21011 (POS 11 allowed) Back/Flank (≥3 cm) → 21931 (POS 11 rarely allowed) Hand/Foot (≤1.5 cm) → 26115 or 28043 (POS 11 allowed) Subfascial Lipomas (Below Fascia) Neck/Thorax (≥5 cm) → 21554 (POS 11 […]
Lipoma Excision Coding – Key Differences & Common Errors
Avoid Costly Coding Errors: Get Lipoma Excision Right! Compass reviews thousands of dermatology records annually, frequently identifying CPT® coding errors – most commonly, lipoma excisions misclassified as cutaneous lesion removals. These errors can trigger reimbursement denials and negatively impact MIPS quality measures 355 and 357. Why Proper Coding Matters The Current Procedural Terminology (CPT®) manual […]
Why Your Practice Needs to Review and Update Your Compliance Plan in 2025
HHS OIG requires physician practices to have a written compliance plan and program. The compliance plan addresses practice adherence to laws, regulations, and ethical standards. That said, many compliance plan documents are outdated or incomplete, either by failing to address the latest guidelines from HHS OIG or by omitting guidance from HHS OIG and other […]
Navigating South Carolina’s Healthcare Compliance Landscape
Healthcare providers in South Carolina face a distinct and evolving regulatory environment. From the recent restructuring of state agencies to specific mandates for prescriptions and procedures, staying compliant is complex. Compass Healthcare Consulting provides tailored support, helping practices from the Upstate to the Lowcountry navigate these rules efficiently. Key South Carolina Compliance Requirements SC’s regulations […]
Florida Healthcare Compliance: Unique Regulatory Environment in the Sunshine State
Operating a healthcare practice in Florida means navigating a complex web of state-specific agencies and rules. Compass Healthcare Consulting provides the localized expertise you need to ensure compliance across the Sunshine State, from managing AHCA standards to adhering to strict prescription monitoring protocols. Key Florida Compliance mandates Florida’s regulatory framework is designed for high patient […]
