Representatives of Physicians Group Management (PGM Billing) recently returned from attending and exhibiting at Lab Institute 2017. This meeting, hosted by G2 Intelligence, brings together professionals from throughout the lab industry for three days of education and networking. In this ever-changing, ever-evolving healthcare environment, many sessions focused on the top challenges facing laboratories. Here are […]
Medicare Provides Guidance on Laboratory Services Consolidated Billing
When laboratory services are billed by providers other than the end-stage renal disease (ESRD) facility and the laboratory service furnished is designated as a service that is included in the ESRD Prospective Payment System (PPS), Medicare will reject or deny the claim. This is according to recent issue of Medicare Quarterly Provider Compliance Newsletter, a […]
Medicare Provides Guidance on Facet Joint Injection Billing
Medicare has found that insufficient documentation is a common cause for improper payments for facet joint injection procedures. This is according to a recent issue of Medicare Quarterly Provider Compliance Newsletter, a newsletter from CMS developed to help providers to avoid common billing errors and other erroneous activities when dealing with the Medicare Program. The […]
CMS Increases Definitive Drug Testing Reimbursement
The Centers for Medicare & Medicaid Services (CMS) will increase reimbursement for toxicology drug confirmation codes in 2017. Background For 2016, CMS implemented four new HCPCS G codes for definitive drug testing: G0480 G0481 G0482 G0483 CMS priced these codes using a crosswalking fo rmula. The first two tests performed were paid at the full […]
Gastroenterology Billing Compliance: Enteral Infusion Pumps
The Centers for Medicare & Medicaid Services (CMS) has released a video that contains guidance to help providers bill correctly for enteral infusion pumps. Medicare Part B covers enteral nutrition supplies and equipment (feeding pump) under the prosthetic device benefit. The two-minute video discusses Medicare coverage criteria for enteral infusion pumps and the four pieces […]
Keep Out of Hot Water: Watch This False Claims Act Compliance Video
The Centers of Medicare & Medicaid Services (CMS) is reminding healthcare organizations about the importance of complying with the False Claims Act. False claims are not claims with innocent billing mistakes. Rather, providers know these claims are false. They include services that are: Not rendered Upcoded Not supported by the patien’’s medical record Part of […]
Medicare Releases 2017 Ambulatory Surgery Center Payment Final Rule
The Centers for Medicare & Medicaid Services recently released its 2017 ambulatory surgery center (ASC) payment final rule. There were a few changes worth noting, according to the national ASC Association (ASCA). 1. Payment increase. ASC payment rates will increase by 1.9%, which is larger than the 1.2% identified in the proposed rule. 2. Procedures […]
Laboratory Medical Billing Compliance Fact Sheet for Urine Drug Screening
The Centers for Medicare & Medicaid Services (CMS) has released a new provider compliance fact sheet concerning laboratory billing. More specifically, the fact sheet concerns requisitions or orders for urine drug screening laboratory tests. The fact sheet noted that a HHS report revealed “laboratory tests – other,” which includes drug screenings, had an improper payment […]
CMS Releases Laboratory Billing Compliance Fact Sheet
The Centers for Medicare & Medicaid Services (CMS) has released a new provider compliance fact sheet concerning laboratory medical billing. The fact sheet noted that a HHS report revealed “laboratory tests – other” (e.g., urine drug screening, medication assays, genetic tests, tissues examination, blood tests) had an improper payment rate of 39 percent, with a […]
Medical Billing Outsourcing on the Rise: 5 Contributing Factors
A new report by Grand View Research examines the growth of medical billing outsourcing. Grand View projects the outsourcing market to grow by more than 150% from 2015 to 2024. Here are five of the factors that will contribute to the significant growth, according to Grand View: Current systems in practice for managing revenue are […]