Incorrect Insurance It is important to ensure all of the correct information is on the claim to prevent delays in payments. Making sure the correct and up to date insurance is obtained can prevent a number of denials and rejections; both of which cause a delay in payment. 1. Is The Plan Active? Verifying eligibility […]
November Bulletin – UnitedHealthcare’s COVID-19 Response – Update
UnitedHealthcare’s COVID-19 Response – Update Telehealth Throughout the public health emergency (currently set to end on January 20, 2021), UHC is extending the cost share waiver for COVID-19 in-network telehealth services. UHC will also waive cost share for COVID-19 treatment until December 31, 2020. For out-of-network services, the cost share for COVID-19 testing […]
Top Challenges Facing Labs Today: 4 Key Takeaways From Lab Institute 2017
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 […]
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). […]
Highlights of Policy and Payment Changes to the Medicare Physician Fee Schedule for 2015
The Centers for Medicare & Medicaid Services (CMS) recently issued its final rule that updates payment policies and rates for services furnished under the Medicare Physician Fee Schedule (PFS) in 2015. Here are some of the highlights of the policy and payment changes for services furnished under the PFS. Screening and diagnostic digital mammography. Until […]
Coding Guidance for Smoking Cessation Counseling
The American Psychiatric Association provides a two-page resource discussing procedure coding for smoking cessation counseling. There are a number of different procedure codes that can be used to describe services provided to encourage changes in behavior of individuals who use tobacco. The resource identifies the CPT and HCPCS codes that describe smoking/tobacco cessation counseling, as […]
Free Orthopedic ICD-10 Resources
The Centers for Medicare & Medicaid Services, as part of its “Road to 10: The Small Physician Practice’s Route to ICD-10,” offers a series of valuable, free ICD-10 resources for orthopedic surgeons. These resources include the following: 1. Common orthopedics codes. An illustrative sample of high-impact diagnosis codes related to common conditions that you may […]
Medicare’s Final 2015 ASC Payment Rule Adds 11 Spine Procedures to Payable List
The Centers for Medicare & Medicaid Services (CMS) has released its final 2015 ambulatory surgery center (ASC) payment rule (pdf), according to an ASC Association report. In the final rule, CMS finalized the addition of the following 11 spine codes to the ASC-payable list: 22551 — Neck spine fuse&remov bel c2 22554 — Neck spine […]
CMS Establishes New Physician Specialty Code for Interventional Cardiology
The Centers for Medicare & Medicaid Services has announced (pdf) the establishment of a new physician specialty code for interventional cardiology: C3. According to an American College of Cardiology report, C3 “allows CMS to distinguish an interventional cardiologist from a clinical cardiologist when billing for Medicare services.” Previously, no such mechanism existed. As a result, […]
Proper Modifier -59 Use for Postoperative Pain Management by Anesthesiologists
In a June blog post, we noted that CMS had updated an MLN Matters article to clarify the proper use of modifier -59. When this MLN Matters article (SE1418) was released, the American Society of Anesthesiologists issued a Physician and Practice Management Memo to bring attention to the publication. In this memo, ASA also provides […]