The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to Medicare-enrolled providers concerning reporting changes in enrollment information. Failure to comply with the requirements to report changes in Medicare enrollment information could result in the revocation of Medicare billing privileges. All physicians, non-physician practitioners (e.g., physician assistants, nurse practitioners, clinical nurse specialists, […]
Clinical Diagnostic Lab Tests Payment System Final Rule: FAQs from CMS
The Centers for Medicare & Medicaid Services (CMS) has published 45 frequently asked questions (FAQs) and CMS responses about the Medicare Clinical Diagnostic Laboratory Tests (CDLTs) payment system final rule. CMS announced on June 17 the release of the final rule, which implemented section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA). […]
Happy Medical Biller’s Day!
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 Reviews Qualifiers for ICD-10 Diagnosis Codes on Electronic Claims
The Centers for Medicare & Medicaid Services (CMS) has issued a reminder about how healthcare providers should use qualifiers for ICD-10 diagnosis codes submitted on electronic claims. CMS notes that when you submit electronic claims for services, remember the following: Claims with ICD-10 diagnosis codes must use ICD-10 qualifiers; all claims for services on or […]
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 […]
Improve Your Coding in 2016: 5 Tools to Use
Proper medical coding is critical for many reasons. They include receiving proper payment for services rendered, limiting denials and maintaining compliance with payor rules. Throughout 2015, PGM Billing launched a number of practice management tools that help ensure proper coding. These tools are free to access and use, and can be shared with coworkers and […]
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 […]
CMS Issues 2016 HCPCS Update
The Centers for Medicare & Medicaid Services (CMS) has posted its final Level II HCPCS application determinations for 2016. Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies and services not included in the CPT-4 codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, […]
2016 CPT Gastroenterology Coding Sheets: Colonoscopy and ERCP
The American Society for Gastrointestinal Endoscopy (ASGE) has published two new coding sheets in order to assist practices in understanding and implementing GI-specific coding. As ASGE notes, the purpose of the coding sheet is to “provide a high level overview to support practices as they prepare for 2016.” Coding sheets are available for: Colonoscopy (CPT […]