Every time a health claim is denied, an insurance company makes more money. But it’s no “wonderful life” for healthcare providers and patients when faced with a denied claim. Claim denials create significant challenges for both parties. For providers, claims follow up is a time-consuming, costly and often unsuccessful process. For patients, a denied claim […]
CMS Publishes Educational Resources for Chiropractic Services
Late last year, CMS updated and issued a pair of educational resources that address Medicare coverage of chiropractic services. The Medicare Learning Network booklet on chiropractic services (pdf) outlines the standards chiropractors must meet to render payable services under the program; common care provision scenarios (including exceptions) and actions that Medicare would take as a […]
Medicare Increases Scrutiny of Billing E/M Services With Allergy Testing or Allergy Immunotherapy
Medicare is paying closer attention to organizations that bill evaluation and management codes reported with allergy testing or allergy immunotherapy. 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 […]
Billing Tip: Ensure Visits Billed as ‘Incident To’ Meet Medicare Criteria
The U.S. Department of Health and Human Services (HHS) is more closely scrutinizing services billed at physician reimbursement levels but performed by nonphysicians, according to a Medical Economics report HHS indicated its intention to take a closer look at these “incident-to” services, which are often performed by nurse practitioners and physician assistants, in its Office […]
Free EHR Resource: ‘EHR Contracts: Key Contract Terms for Users to Understand’
The Office of the National Coordinator for Health Information Technology has released a free, downloadable guide designed to assist providers who plan to acquire electronic health record (EHR) systems. The guide, titled “EHR Contracts: Key Contract Terms for Users to Understand,” is intended to help buyers better understand critical EHR contract terms. As the report […]
PGM’s Credentialing Specialist Justine Marquard Contributes Credentialing Article to Becker’s ASC Review
Justine Marquard, credentialing specialist at Physicians Group Management, has contributed a column to ambulatory surgery center (ASC) publication Becker’s ASC Review. The story is titled “10 Best Practices for ASCs to Ensure Successful Credentialing.” To view the column, click here. Becker’s ASC Review features general business, legal and clinical guidance on topics including joint ventures, […]
New Case Study: Concierge Practice Outsources Medical Billing to PGM Billing
A new case study is now available for download in our Library. The case study details the experience of Private Physicians Medical Associates, a mid-sized concierge practice in Newport Beach , Calif., that selected AmazingCharts as its electronic medical records software and then outsourced its medical billing to PGM Billing to help overcome many challenges, […]
New Case Study: Allergy Practice Outsources Medical Billing to PGM Billing
A new case study is now available for download in our Library. The case study details the experience of A2 Medical Group, a multi-office allergy practice, that outsourced its medical billing to PGM Billing to help overcome challenges such as high days in accounts receivable (A/R), poor coding and inadequate A/R follow up. Hear from […]
Physical Therapy Services Facing Reimbursement Cuts
The passage of the American Taxpayer Relief Act of 2012 includes the addition of a provision that will reduce Medicare reimbursement to physical therapists come April 1, 2013, according to the American Physical Therapy Association. The decline would be slightly offset, but the bottom line is physical therapists will see a reduction in Medicare reimbursement […]
ICD-10: Are You Preparing for the Switch?
The deadline for the transition to ICD-10 is October 1, 2014. While that may seem far away, CMS notes that providers should expect ICD-10 testing to take up to 19 months. Therefore, it’s imperative for practices to be proactive and begin to implement a transition plan (if they haven’t started one already). For practices that […]