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.

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

Have Medicare Billing Questions? Contact Gerald Rogan, MD