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 […]

The American Rescue Plan

The American Rescue Plan With the signing of the most recent COVID-19 Relief Bill, more people may be able to afford healthcare coverage through the federal and state health insurance marketplaces. The American Rescue Plan (ARP) will help to save millions of people hundreds of dollars in healthcare insurance costs. Those who qualify include those who […]

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 […]