Pam Warren, MHA, COC, CPC, Fellow We’ve all seen that two-page chart in the CPT® book that indicates the place of service code (POS) that is expected to be reported for physician services. But not every physician performs in office settings; not all physicians perform office visits, and some services can be billed by physicians when […]
How Physician Services are Paid
Use the resources here to quickly educate new practitioners and staff about coding and reimbursement. You'll find explanations about code sets and compliance, about Medicare incident-to and shared services rules, and requirements for billing for services provided jointly between a resident and an attending.
Provider-Based Billing | Webinar
Recorded July 17th, 2025
Guest presenter Pam Warren, MHA, COC, CPC, Fellow
Reporting services in provider-based clinics requires knowledge of Medicare rules related to the technical and professional components of visits. It requires understanding of both the CMS 1500 form and the UB04.
Coding Guide – Teaching Physician Rules
The teaching physician guidelines are Medicare rules that allow for payment for services that are performed jointly between a resident and a licensed attending physician (the teaching physician). This downloadable coding guide from CodingIntel provides an explanation of teaching physician rules for E/M services and specialty specific services.
Billing Medical Practice Services for Patients on Hospice
Overview of Hospice Care Additional Services (non-Hospice Organization) Medicare beneficiaries who have a terminal illness with a life expectancy of six months or less can elect to have their end-of-life care provided by a hospice organization (the “hospice”). Medicare then pays hospice to provide all the care that the patient needs that is related to […]
Teaching Physician Rules | Quick Reference Guide
This quick reference guide breaks down who must document what for which services as outlined in Medicare’s teaching physician rules.
How Fees are Set in the Medicare Fee Schedule
How does Medicare set its fees? This is important for other payers because commercial payers often use the values set by Medicare to calculate their fees. This overview provides information and examples to explain how fees are set in the Medicare Fee Schedule. CodingIntel members can start with the brief video introduction and companion slides, […]
Transforming Patient Collections: Expert Insights and Strategies | Webinar
Recorded October 16th, 2024
Guest Presenter Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC
Gain valuable insights on how to effectively respond to industry changes and actionable steps to enhance your revenue cycle management. Join Elizabeth for an engaging and informative webinar centered around navigating the current inflection point in patient collections. Patient financial responsibility is increasing – and it’s time for you to rise to the challenge!
Compliance Guide
You may have heard about the “Seven Elements for an Effective Compliance Plan.” In fact, if you enter that term in a popular web browser “about 575,000” results appear within seconds. Fortunately, compliance and enforcement agencies endorse the elements and provide great examples on what to do – without having to delve much into those […]
Where Does it Say That? | Webinar
Recorded October 9th, 2024
Guest Presenter Pam Warren, MHA, COC, CPC, Fellow
This webinar is a guide for auditors and coders looking for regulatory guidance when they are answering coding, compliance and regulatory questions from practitioners and colleagues. This presentation offers common healthcare compliance scenarios and provides the location of the associated guidance.
Developing an Audit Work Plan to Satisfy Your Compliance Program | Webinar
Recorded September 25th, 2024
Guest Presenter Pam Warren, MHA, COC, CPC, Fellow
There are seven elements of an effective Compliance Plan per the OIG, and one of them is to conduct internal monitoring and auditing.
This presentation will give you some ideas on how to determine what content to audit, how to evaluate your risk, how to set up your audit process, and how best to report your results to your leaders.
CMS’s 2024 Shared or Split Services Policy: Document and Report Them Correctly
In 2024, CPT® expanded its definition of split/shared services, CMS updated their requirements. Neither CMS nor CPT made changes tot his policy for 2025. CPT® expanded its definition of split/shared services in 2024, stating that the substantive portion can be determined by the practitioner who spent more than 50% of the time, or who made […]
Five Novel Reimbursement Opportunities – and More to Boost Your Practice’s Payments | Webinar
Recorded: June 2024
Guest Presenter Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC
The Centers for Medicare & Medicaid Services have approved five new payment opportunities for 2024 – just the beginning of what promises to be a significant shift in the reimbursement landscape for medical practices.
Incident To Services – Medicare
Medicare has specific rules for billing for nurse practitioners and physician assistants and other office staff incident to a physician services in an office. This article includes: Description, explanation and codes for incident-to services Billing and coding rules Brief video overview Enrollment of non-physician practitioners (NPPs) for incident-to billing See our Medicare Incident-to and Shared […]
Shared Services: CPT® and CMS Rules | Webinar
Recorded May 16th, 2024
Shared services are E/M services jointly performed by a physician and non-physician practitioner in a facility setting. The service is reported under the National Provider Identifier (NPI) of the practitioner who performs the substantive portion of the service. The substantive portion of the service can be determined by time or medical decision making (MDM).
OIG Report on Telehealth During the PHE
What? An OIG report without doom and gloom? Fire and brimstone? Slides In February, 2024 the OIG released an audit report of telehealth E/M services performed between March 2020 and November 2020. During this nine-month period practitioners submitted claims for 19 million E/M services. Before I talk about the report though, let me congratulate everyone […]
Teaching Physician – Primary Care Exception
CMS updated the teaching physician rules in 2019, and this article reflects the change. On April 26, 2019 CMS released Transmittal 4283. The transmittal primarily addresses E/M services, but also amends the section of the manual related to the primary care exception. The changes to the primary care section were mostly wording updates. Those rules […]
2025 RVU table with national fee amounts
Looking for 2025 work RVUs? Wondering how much a new code pays? Look no farther. You can download the 2025 CMS national RVU table below. It does not include payment variations after the geographic practice cost indices have been applied. We’ve hidden some columns (which you can unhide) so that you see the code, short […]
How Physician Services are Paid – Overview
Have a new staff member or physician who needs a primer on “how physician services are paid?” This short video is a must see! Learn how all the piece come together, from CPT® and HCPCS, to diagnosis coding and Medicare rules. All in about 15 minutes…
Two Visits for the Price of One? | Multiple Medical Visits on the Same Day
Patients often schedule two medical appointments on the same day with physicians of different specialties. It’s convenient for them. It saves travel time. It may mean the patient or a family member only needs to take one day off work. Can a multi-specialty practice be paid for two visits, when the physicians/non-physician practitioners (NPPs) practice […]
Facility versus Non-Facility in the Physician Fee Schedule
Understanding facility versus non-facility in the physician fee schedule explains the RVU and payment differences that practices receive when performing the same service in different settings. The Medicare Physician Fee Schedule has values for some CPT® codes that include both a facility and a non-facility fee. When CMS develops the fee schedule, each code has […]
What is a Coverage Policy?
National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are Medicare’s coverage policies that describe medical necessity for certain services. Private payers publish their own coverage policies on their Web sites. When services are denied due to medical necessity, no pre-authorization, failing to try less expensive or invasive treatments, this is a good indication there […]