Specific Services
Coverage, Coding, Reimbursement rates for all categories of services including:
- Coverage of drugs that are usually self-administered by the patient;
- Interpretation of Medicare administrative manual and CMS policy decision making
- Review and explain national and local medical review policies and compliance requirements.
- Review medical record documentation applicable to documentation requirements under §1833(e).
- Review claim billing, payment and process of Medicare Administrative Contractors (MACs)
- Review and comment on marketing and promotional tools for a Medicare audience.
- Explain Medicare program rules applicable to hospital outpatient, ambulatory surgery centers, ambulance, physicians, non-physician practitioners, and other providers
- Explain MAC processes including actions of carrier medical directors, medical review, appeals, hearings, administrative law judges, and law enforcement
- Explain the change process for Medicare laws, CMS regulations, rules, and carrier instructions.
- Explain the CPT and HCPCS coding process and related pricing methods.
Medicare B
Coverage, Coding, Reimbursement rates for all categories of services including:
- Physician services, medical and surgical
- Injectable drugs
- Laboratory tests
- Other diagnostic tests
- Medical imaging
- Psychological services
- Physical therapy
- DME
- Ambulance transport
Local Coverage Decisions
Analysis of coverage local coverage decisions (LCDs)
- New
- Reconsideration
- Comments to proposed LCDs
Frequently Asked Questions
These are questions that I can help answer:
- Will Medicare pay for my product?
- Is my product a Medicare benefit?
- Is my product reasonable and necessary to improve health outcomes or influence medical decision-making?
- Does my product qualify under Durable Medical Equipment?
- Am I billing correctly?
- How do I defend against a demand for repayment to Medicare?
- How do I obtain a HCPCS or CPT code and is it important to do so?
- How do I change an unfavorable Local Coverage Decision?
- Should I ask for a National Coverage Decision for my product?
- Will Medicare pay extra for my product when used in an Ambulatory Surgery Center (ASC) or Hospital Outpatient Department?
- Can I obtain add-on payment or pass-through payment for my product?
- How much can we charge Medicare for our new drug?
- How does off-label drug coverage work?
- How do I obtain a new billing code for our DME product?
- How do I change the billing code PDAC has assigned to our DME product?
- Will a commercial insurer cover our product when Medicare does not?
- Will our injectable drug be covered by Medicare when it can be self-administered by the patient?
- Can you call a CMD for me and fix our problem?
Clients & Activities
Here are a few of the clients I have worked with and organizations I have been involved in:
Complete client list available on request
