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). […]
CMS Releases Final Rule on Lab Billing and New Payment System
The Centers for Medicare & Medicaid Services (CMS) has released a final rule requiring laboratories performing clinical diagnostic laboratory tests to report the amounts paid by private insurers for laboratory tests. Medicare will then use these private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) […]
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 […]
PGM Profiled in Becker’s for Revenue Cycle Management Services
PGM Billing, one of the nation’s leading medical billing companies, is profiled in a recent report by Becker’s Hospital Review. The report identifies companies that provide revenue cycle management solutions specific to the healthcare industry. PGM’s profile reads as follows: “Physicians Group Management (Lyndhurst, N.J.). PGM, founded in 1981, offers physician billing services, facility billing […]
CMS: New Drug Testing Laboratory Codes Editing Incorrectly
The Centers for Medicare & Medicaid Services (CMS) has announced it discovered systems errors affecting claims with new drug testing laboratory codes (HCPCS codes G0477 through G0483) with dates of service on or after January 1, 2016. If you are affected, CMS states that your Medicare Administrative Contractor (MAC) will be holding these claims until […]
Free Oncology Billing and Coding Resource: 2016 Update From ASCO
The American Society of Clinical Oncology (ASCO) has published a free, downloadable resource that identifies oncology billing and coding updates for 2016. Topics discussed include the following: New CPT codes (99415 and 99416) Radiation oncology CPT updates New HCPCS codes (J8655, J7508 and J7503) Deleted HCPCS codes Filgrastim HCPCS updates Chemotherapy drugs (replacements) HCPCS codes […]
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 […]