Category: NEWS

Flaws In Medicare Coding Interpretations

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We work with medical oncologists/hematologists across the country in both the private practice and hospital settings. Based on our experience, I would like to point out a couple of key flaws in the current Medicare code interpretations. First, several of our oncology physician clients in various states have recently experienced what I consider to be unfair treatment and flat out harassment by local carriers over the topic of “medical necessity”….

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AMA Rejects Request For New Hem/Onc CPT Codes

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Neltner Billing and Consulting recently submitted documents to the AMA suggesting that the infusion coding oncology and hematology rely on for appropriate payment of professional physician work and practice expense is failing in its purpose. Along with those documents we made requests for revised CPT coding to better reflect the work physicians are truly performing. Unfortunately, the CPT Panel rejected our requests for the following reasons – with which we…

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Neltner Abstract Accepted by ASCO

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Neltner Billing and Consulting is honored that the American Society of Clinical Oncology accepted our abstract, “An Examination of Oncology Drug Purchasing Compared to Average Sales Price” for online posting. You can view the full abstract on the ASCO website.

Persistence Pays Off: A Success Story Worth Discussing

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On behalf of a client, we have a great success story to report. One of our oncology clients was having continued denials with a large private pay insurance company. Regarding this particular situation, the oncologist was following AMA coding guidelines, however, the insurance company did not agree. The issue at hand was relative to CPT 96413, used for initial drug infusion, along with CPT 96416, used for chemotherapy administration via…

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Reality is in the Results, and It Is No Surprise: Your ASP Tallies

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In a recent Neltner News article, we asked for you to complete our short ASP “worksheet”. We’ve had several responses from oncology/hematology practices, comparing what they are paying to the Medicare allowable. The results? No surprise: most physicians are paying way too much. We will continue to update this as we get more data from hematologists/oncologists across the country. Now that you see the data, is it reality or myth…

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