Governors from multiple states (including Alabama and Virginia) have declared March 31 to be Medical Biller’s Day for 2016. A portion of the proclamation from Alabama reads as follows: “WHEREAS, Medical Billers provide a much needed service to doctors and other healthcare providers and provide a vital segment of the health care industry; and “WHEREAS, […]
CMS Publishes Series of Chiropractic Billing Resources
The Centers for Medicare & Medicaid Services (CMS) has published three new MLN Matters special edition articles for chiropractors and other practitioners who submit claims to Medicare Administrative Contractors (MACs) for chiropractic services provided to Medicare beneficiaries. MLN Matters SE1601 is titled “Medicare Coverage for Chiropractic Services – Medical Record Documentation Requirements for Initial and […]
CMS Publishes Final Rule on Self-Identified Medicare Overpayments
The Centers for Medicare & Medicaid Services (CMS) has published a final rule on reporting and returning self-identified Medicare overpayments. The rule is specifically for Medicare parts A and B healthcare providers and suppliers. A separate final rule was published in May 2014 that addressed Medicare Parts C and D overpayments. The major provisions for […]
CMS Issues 2016 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
The Centers for Medicare & Medicaid Services (CMS) has issued a new change request (CR) that should be of interest to clinical diagnostic laboratories that submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries. CR 9465 provides instructions for the calendar year (CY) 2016 clinical laboratory fee schedule, mapping for new […]
PGM and ICANotes Publish Whitepaper on Outsourced Billing for Mental Health
PGM Billing, a leading provider of integrated physicians billing services, practice management and revenue cycle management services, and ICANotes, a comprehensive electronic healthcare records solution for psychiatry and behavioral health professionals, have published a whitepaper discussing the benefits of the PGM and ICANotes’ billing platform for mental health professionals. The whitepaper, titled “The Case for […]
Medicare Increases Payments for Incomplete Colonoscopies
The Centers for Medicare & Medicaid Services (CMS) has announced it is revising the method for calculating payment for incomplete colonoscopies billed with modifier -53. Effective January 1, 2016, the new payment rates will apply when modifier -53 (discontinued procedure) is appended to Current Procedural Terminology (CPT) codes 44388, 45378, G0105 and G0121. As CMS […]
Medicare Identifies Improper Payments Associated With Extracorporeal Shock Wave Lithotripsy
Medicare has disclosed the primary cause for improper payments associated with extracorporeal shock wave lithotripsy (ESWL). This is according to a recent issue of Medicare Quarterly Provider Compliance Newsletter (pdf), a newsletter from CMS developed to help providers understand the major findings identified by Medicare administrative contractors, recovery auditors and other governmental organizations, such as […]
17 FAQs About Billing Medicare for Chronic Care Management Services
The Centers for Medicare & Medicaid Services (CMS) has released a new, special MLN Matters article (pdf) on chronic care management (CCM) services frequently asked questions. Here are the 17 FAQs — and their answers provided by CMS — regarding billing CCM services to the physician fee schedule (PFS) under CPT code 99490. 1. CPT […]
Medicare Identifies Most Common Causes of Improper Payments for ESRD-Related Services
Medicare has determined that the majority of the improper payments for end stage renal disease (ESRD)-related services were due to insufficient documentation. This is according to a recent issue of Medicare Quarterly Provider Compliance Newsletter (pdf), a newsletter from CMS developed to help providers to avoid common billing errors and other erroneous activities when dealing […]
Understanding How to Code and Bill for Transcatheter Mitral Valve Repair
In August 2014, the Centers for Medicare & Medicaid Services issued a National Coverage Determination (NCD) for transcatheter mitral valve repair (TMVR). This decision memo stated CMS would cover TMVR for mitral regurgitation (MR) under Coverage with Evidence Development (CED) for the treatment of MR when furnished for an FDA-approved indication with an FDA-approved device […]