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 […]
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 […]
HARVARD PILGRIM HEALTH CARE AND TUFTS HEALTH PLAN MERGE
HARVARD PILGRIM HEALTH CARE AND TUFTS HEALTH PLAN MERGE In January of 2011, Harvard Pilgrim and Tufts announced an attempted merger that was ultimately called off. Both companies found that they were stronger as separate companies than they would be if they were to merge. Now, a decade later, Harvard Pilgrim Health Care and Tufts […]
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 […]
COVID-19 UPDATES – January Bulletin
After almost a full year of battling the Coronavirus Pandemic with masks, lockdowns and social distancing, a new headline is making news: The virus that causes COVID-19 has changed, making it more contagious. Health experts report that at least one new “super strain” of the virus is already in the U.S. and another highly […]
COVID-19 UPDATE
It’s finally here! The first COVID-19 vaccinations were given this week after nine long months of enduring the world-wide pandemic. Since the start of the COVID-19 pandemic, the federal government, through Operation Warp Speed, has been working on one or more vaccinations. Healthcare workers and long-term care facility staff and patients were the first […]
December Blog – Changes Coming to Medicare in 2021
There are several changes coming to Medicare benefits for 2021: Every year, a cost-of-living adjustment (COLA) is announced. In 2020, benefits increased by 1.6% and for 2021, benefits will increase by 1.3%. This will result in an average increase of about $20 per month. The Medicare cost increases for 2021 are as follows The standard […]