Insufficient Documentation Triggering Improper Payments for Laparoscopic Hernia Repair

Insufficient documentation is the cause of the vast majority of improper payments for laparoscopic hernia repairs. This is according to a recent issue of Medicare Quarterly Provider Compliance Newsletter, a newsletter from the Centers for Medicare & Medicaid Services developed to help providers understand the major findings identified by Medicare administrative contractors, recovery auditors and […]

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 […]

10 Tips for Complying With Laboratory Services Documentation Requirements

The Centers for Medicare & Medicaid Services (CMS) report that the majority of improper payments for laboratory services identified by the Comprehensive Error Rate Testing (CERT) Program were attributable to insufficient documentation. Insufficient documentation means that something was missing from the medical records (e.g., signed physician order, documentation to support intent to order, documentation to […]

PGM Billing to Attend Lab Institute 2015

PGM Billing will have company representatives attending the 33rd Lab Institute taking place October 14-16, 2015, in Washington, D.C. PGM sends representatives to the meeting every year to ensure the company remains on the cutting edge of issues impacting laboratories and laboratory billing. Lab Institute 2015 features impressive pre-conference workshops and a robust main workshop […]

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 […]

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 […]