Free Orthopedic ICD-10 Resources

The Centers for Medicare & Medicaid Services, as part of its "Road to 10: The Small Physician Practice's Route to ICD-10," offers a series of valuable, free ICD-10 resources for orthopedic surgeons.

These resources include the following:

1. Common orthopedics codes. An illustrative sample of high-impact diagnosis codes related to common conditions that you may encounter. Several of the examples demonstrate the increased specificity available in ICD-10.

2. Orthopedics clinical documentation primer. This document introduces ICD-10 clinical documentation changes for common orthopedic conditions. It highlights the increased specificity and laterality requirements and provides brief descriptions of the related documentation nuances significant to an orthopedic practice.

3. Orthopedics clinical scenarios. Sample, outpatient-focused scenarios to illustrate specific ICD-10 clinical documentation considerations. These examples underscore the importance of including the proper level of detail needed to support the selection of the most appropriate ICD-10 diagnosis codes based on a patient's circumstance.

4. Orthopedics ICD-10 webinar. Led by Joseph Nichols, MD, board-certified orthopedic surgeon and co-chair of the WEDI Translation and Coding Work Group, learn about ICD-10 documentation and coding concepts, including the clinical impact of ICD-10 and orthopedi-specific documentation requirements, changes and new concepts.

5. Other orthopedic ICD-10 training resources. These include tools intended to help with documentation training for physicians, nurse practitioners, physician assistants and other staff who document in the patient medical record; coding training for staff members who work with codes on a regular basis; and overview training for staff members engaged in administrative functions.

The transition to ICD-10 is expected to cause significant disruptions in payments as well as coding and billing processes. To reduce the negative impact of the transition to ICD-10 on your organization, consider outsourcing your billing to a leading orthopedic billing company like PGM billing. For the past 30 years, PGM has been providing practice and ASC billing services to orthopedic surgeons nationwide. Contact PGM today to find out how they can help ensure you capture the reimbursement you organization rightly earns in a timely manner.

Register for Free Conference Call on Changes to Physician Quality Reporting Programs

The Centers for Medicare & Medicaid Services has announced it is hosting a free Medicare Learning Network Connects national provider call to provide an overview of changes to the physician quality reporting programs as per the 2015 physician fee schedule final rule.

The call is scheduled to take place Tuesday, Dec. 2 from 1:30-3 p.m. ET.

Changes to be addressed include those made to the physician quality reporting system (PQRS), value-based payment modifier, physician compare, electronic health record (EHR) incentive program, comprehensive primary care initiative and Medicare shared savings program.

PQRS topics covered will include changes to reporting mechanisms, individual measures and measures groups for inclusion in 2015, criteria for satisfactory reporting under claims-based reporting, qualified registry-based reporting and EHR-based reporting options.

CMS states this presentation will cover satisfactory participation under the qualified clinical data registry option to avoid future payment adjustments and requirements for eligible professionals wanting to report one time across several Medicare quality reporting programs.

Attendees will also learn how CMS continues to phase in and expand the application of the value-based payment modifier in 2017, based on performance in 2015. CMS will also describe how the value-based payment modifier aligns with the reporting requirements under the PQRS.

A question and answer session will follow the presentations.

To register, click here. Register early as space may be limited.

Significant Developments for Gastroenterology in Medicare's 2015 Final Rules

The Centers for Medicare & Medicaid Services (CMS) has released its final rule for physician reimbursement under Medicare for 2015, and it includes a few developments that should be of interest to gastroenterologists.

According to an American Gastroenterological Association report, highlights include the following:

  • CMS has delayed the valuation of the lower gastrointestinal endoscopy codes until 2016.
  • CMS reversed some of the significant cuts to upper GI services that were implemented in the 2014 Medicare payment rule.

As we previously reported, CMS also released its 2015 final rule on the hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system policy changes and payment rates.

AGA notes that both OPPS and ASC payments for GI services received a positive update for 2015.

Looking for help with gastroenterology billing? Contact PGM Billing to learn what we can do for your GI practice and why we're quickly becoming one of the nation's leading ASC billing services!

Free Medicare Resource: Appeals Process Podcast

A free 15-minute podcast on the Medicare appeals process is now available from the Centers for Medicare & Medicaid Services (CMS).

According to CMS, the podcast is designed to provide education on the five levels of claim appeals in original Medicare (Medicare Part A and Part B).

It includes details explaining how the Medicare appeals process applies to providers, participating physicians and participating suppliers in addition to including more information on available appeals-related resources.

The podcast is available in mp3 audio format. A transcription of the podcast is also available.

Download the podcast on the Medicare appeals process.

Struggling with appealing denied claims from Medicare and third-party payors? Find out how PGM, a leading physician billing company, can help. Contact PGM today!

American Academy of Family Physicians Publishes Summary of 2015 Medicare Physician Fee Schedule

Last week, the Centers for Medicare & Medicaid Services (CMS) released the final version of its 2015 Medicare physician fee schedule (pdf).

As a service to family physicians, the American Academy of Family Physicians (AAFP) has published a 16-page summary of the nearly 1,200-page final rule.

The summary is intended to note the highlights of the final rule particularly relevant to primary care.

AAFP notes that these include implementation of the new chronic care management fee, handling of misvalued CPT codes, and addressing CMS' Open Payments program regulations.

Access the AAFP summary here (pdf). To read AAFP President Dr. Robert Wergin's statement on the final rule, click here.

Are you concerned about the effectiveness of your practice's collections efforts? Worried that changes to coding and billing rules, including those in the final rule, will make receiving proper compensation for the services you provide even more difficult? Consider outsourcing your primary care billing to PGM Billing.

PGM is highly a leading medical billing service provider experienced in both internal medicine billing and family medicine billing, with nearly 40% of PGM's clients offering primary care services. Contact PGM today and learn how our certified team can manage all aspects of your medical billing.


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