The American Medical Association has issued a new Current Procedural Terminology (CPT) code for influenza vaccine Flucelvax. The code — CPT 90674 — went into effect on August 1, 2016, for Medicare claims. However, as the Centers for Medicare & Medicaid Services states, Medicare claims processing systems will not be able to accept the new […]
CMS Publishes Video on Psychotherapy and Psychiatry Billing
The Centers for Medicare & Medicaid Services (CMS) has published a video on provider compliance relating to psychotherapy and psychiatry medical billing. The video includes pointers to properly submit documentation for these services, more specifically the use of add-on codes when billing for same day evaluation and management and psychotherapy services, and three factors needed […]
CMS Issues Reminder About Reporting Medicare Enrollment Changes
The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to Medicare-enrolled providers concerning reporting changes in enrollment information. Failure to comply with the requirements to report changes in Medicare enrollment information could result in the revocation of Medicare billing privileges. All physicians, non-physician practitioners (e.g., physician assistants, nurse practitioners, clinical nurse specialists, […]
Clinical Diagnostic Lab Tests Payment System Final Rule: FAQs from CMS
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 […]