BILLING MISTAKES – PART II – JULY BULLETIN

Incorrect Insurance It is important to ensure all of the correct information is on the claim to prevent delays in payments. Making sure the correct and up to date insurance is obtained can prevent a number of denials and rejections; both of which cause a delay in payment. 1. Is The Plan Active? Verifying eligibility […]

November Bulletin – UnitedHealthcare’s COVID-19 Response – Update

  UnitedHealthcare’s COVID-19 Response – Update   Telehealth Throughout the public health emergency (currently set to end on January 20, 2021), UHC is extending the cost share waiver for COVID-19 in-network telehealth services. UHC will also waive cost share for COVID-19 treatment until December 31, 2020. For out-of-network services, the cost share for COVID-19 testing […]

Top Challenges Facing Labs Today: 4 Key Takeaways From Lab Institute 2017

Representatives of Physicians Group Management (PGM Billing) recently returned from attending and exhibiting at Lab Institute 2017. This meeting, hosted by G2 Intelligence, brings together professionals from throughout the lab industry for three days of education and networking. In this ever-changing, ever-evolving healthcare environment, many sessions focused on the top challenges facing laboratories. Here are […]

Highlights of Policy and Payment Changes to the Medicare Physician Fee Schedule for 2015

The Centers for Medicare & Medicaid Services (CMS) recently issued its final rule that updates payment policies and rates for services furnished under the Medicare Physician Fee Schedule (PFS) in 2015. Here are some of the highlights of the policy and payment changes for services furnished under the PFS. Screening and diagnostic digital mammography. Until […]

Coding Guidance for Smoking Cessation Counseling

The American Psychiatric Association provides a two-page resource discussing procedure coding for smoking cessation counseling. There are a number of different procedure codes that can be used to describe services provided to encourage changes in behavior of individuals who use tobacco. The resource identifies the CPT and HCPCS codes that describe smoking/tobacco cessation counseling, as […]

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 […]

Medicare Provides Guidance on Billing for Implantable Automatic Defibrillators

Medicare has found that approximately 85% of improper payments relating to the billing of implantable automatic defibrillators 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 […]

CMS Establishes New Physician Specialty Code for Interventional Cardiology

The Centers for Medicare & Medicaid Services has announced (pdf) the establishment of a new physician specialty code for interventional cardiology: C3. According to an American College of Cardiology report, C3 “allows CMS to distinguish an interventional cardiologist from a clinical cardiologist when billing for Medicare services.” Previously, no such mechanism existed. As a result, […]