Mark N. Painter, CPMA

Mark N. Painter, CPMA

PRS Consulting, LLC

Thornton, Colorado

Mark N. Painter is a managing partner of PRS Consulting LLC, the CEO of PRS Urology Service Corporation, the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc., and CEO of Relative Value Studies, Inc. Since co-founding PRS in 1989, Mr. Painter has served as the primary coding resource for the PRS products currently produced and marketed in conjunction with 9 National Specialty Organizations including hotlines, coding manuals, and quick reference tools, the internet-based application codingtoday.com, and seminars. He has lectured to a variety of groups concerned with healthcare reimbursement. Mr. Painter’s extensive knowledge of physician documentation, as well as coding and reimbursement issues, has allowed him to assist insurance companies, physicians and their staff members, legal counsel, actuaries, specialty societies, consultants, and the medical industry on a daily basis. Mr. Painter has been the lead for the company on multiple corporate/physician integrity agreements serving as the Independent Review Organization (IRO), and has successfully overseen the review and continued participation in Medicare of several practices from multiple specialties. Mr. Painter has been commended for his education and direction for appropriate documentation and coding by multiple Medicare medical directors with whom he has shared the podium during national and regional medical meetings. He serves as an expert in legal counsel for bio device companies, medical directors, and pharmaceuticals.

Disclosures:

Articles by Mark N. Painter, CPMA

HIFU Bill Coding 2021

Mark N. Painter, CPMA, managing partner of PRS Consulting LLC, the CEO of PRS Urology Service Corporation, the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc., and CEO of Relative Value Studies, Inc., discusses changes to Medicare billing in 2021, covering HIFU (high intensity-focused ultrasound) and detailing how the procedure is reimbursed. He details how the new CPT code for 2021, code 55880, is used for ablation of malignant prostate tissue, transretally approached, using high intensity-focused ultrasound (HIFU) and ultrasound guidance. Mr. Painter details how Medicare has set up facility payments: HIFU can only be billed once per date of service, and many Medicare carriers still consider HIFU as a non-covered service. Also, if the HIFU is done at a non-participating facility, it becomes patient responsibility. The new code does not allow for co-surgeons or assistant surgeons. He points out that there is an established fee schedule for facilities and appropriate values for the code, and advises to look at coverage rules and to keep an eye on individual carriers to see whether they will follow NGS moving forward or not. Mr. Painter also advises to check with each payer before providing this service to find where coverage is, where patient responsibilities lie, and to juggle that with your charges and reimbursement activity.

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UPDATED – Billing and Regulations for Telehealth During COVID-19

Mark N. Painter, CPMA, managing partner of PRS Consulting, LLC, CEO of PRS Urology Service Corporation and the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc. (PRS), and CEO of Relative Value Studies, Inc., gives an in-depth guide for how to bill for telehealth visits as they increase during the COVID-19 crisis. He gives background information on current telehealth and telemedicine regulations and billing, including CMS (Medicare & Medicaid), as well as detailing temporary changes to the Stafford Act that have been enacted during the current coronavirus pandemic to accommodate the increased number of remote visits. Mr. Painter further details relevant billing codes and requirements for getting them approved, circumstances where co-pays may be waived, as well as requirements for treating new patients. He also covers the current situation and possible changes to multi-state practitioning as it relates to distance treatment.

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