PAYER ID CHANGES FOR 2021 The first half of 2021 has seen a lot of Payer ID and/or claims address changes. Making sure claims are submitted to the correct Payer ID will prevent delays in payments and an increased amount of denials. Below are some payer ID updates to make note of and update. CHAMPVA […]
COVID-19 VIRUS UPDATE – June Bulletin
Delta Variant In December 2020, a new COVID-19 variant was found in India. Now, as of June 2021, just six months after the discovery of the Delta Variant, it is the dominant strain in both India and the United Kingdom. Some key factors to know about the delta variant, also known as B1617.2, are the […]
Billing Mistakes – Part 1 – June Bullein
BILLING MISTAKES – PART I Common Rejections Front-end rejections not only cause a delay in payment, but it adds additional time spent on a single claim. Most rejections can be avoided by making sure all of the required information is obtained and entered into the patient’s chart prior to generating the claim. Identifying some of […]
USDA COVID-19 VACCINE UPDATES – May Bulletin
USDA COVID-19 VACCINE UPDATES On May 10, 2021 the U.S. Food & Drug Administration expanded emergency use for the Pfizer-BioNTech COVID-19 vaccine for adolescents as young as 12 years old. Initially, it was only approved for persons 16 an older; however, according to Acting FDA Commissioner Janet Woodcock, MD on fda.gov (link below), the expansion […]
May Bulletin – INSURANCE UPDATES
INSURANCE UPDATES Several insurance providers have updated their billing guidelines to coincide with the extension of the Public Health Emergency (PHE) period, which is now July 20, 2021. CIGNA The cost-share waiver for COVID-19 testing, screening or diagnostic services will end on the last day of the PHE period. Cigna has also extended accommodations related […]
APRIL BULLETIN – NEW BILLING LAWS SET TO TAKE EFFECT IN 2022
New laws under the No Surprise Act will prevent providers from billing patients more than in-network cost-sharing for out-of-network services and will even establish an arbitration process to resolve unexpected out-of-network charges. The new law take effect January 1, 2022 and applies to nearly all private health plans offered by employers (including grandfathered group health […]
APRIL BULLETIN – AN IN DEPTH LOOK AT THE NEW 2021 E&M CODING GUIDELINES
As of January 1, 2021, the American Medical Association and the Centers for Medicare and Medicaid Services implemented changes to evaluation and management services. The changes are meant to decrease the amount of required documentation and increase the amount of time spent with patients. The E&M codes affected are 99201-99215 and all other E&M codes […]
March Bulletin – COVID-19 Vaccination Update
COVID-19 VACCINATION UPDATE As of February 27, 2021, four COVID-19 vaccines have been approved for emergency use and have all been issued CPT codes (please see “Coding Update – 2021” on the PGM Blog for CPT codes and NDC numbers). On March 3, 2010 the Centers for Medicare and Medicaid Services (CMS) released the […]
March Bulletin – Coding Updates for 2021
Coding Updates – 2021 The continued development of COVID-19 treatments and vaccines has prompted updates in CPT coding and billing guidelines. In addition to the updated E&M code requirements, the American Medical Association developed COVID-19 codes for each of the four coronavirus vaccines and their administrations. 91300: this is for the Pfizer vaccine only. For […]
February 2021 Bulletin – CHANGES TO THE 2021 CPT CODE SET
2021 has arrived, which means so have changes to the code set. The American Medical Association reported that overall there are 328 editorial changes, including 206 new codes, 54 deletions, and 69 revisions. The AMA has also stated that these changes include the “first major overhaul of office visit and outpatient E/M coding” since the […]