PGM Billing, a leading provider of integrated physicians billing services, practice management and revenue cycle management services, and ICANotes, a comprehensive electronic healthcare records solution for psychiatry and behavioral health professionals, have published a whitepaper discussing the benefits of the PGM and ICANotes’ billing platform for mental health professionals. The whitepaper, titled “The Case for […]
Medicare Increases Payments for Incomplete Colonoscopies
The Centers for Medicare & Medicaid Services (CMS) has announced it is revising the method for calculating payment for incomplete colonoscopies billed with modifier -53. Effective January 1, 2016, the new payment rates will apply when modifier -53 (discontinued procedure) is appended to Current Procedural Terminology (CPT) codes 44388, 45378, G0105 and G0121. As CMS […]
CMS Issues 2016 HCPCS Update
The Centers for Medicare & Medicaid Services (CMS) has posted its final Level II HCPCS application determinations for 2016. Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies and services not included in the CPT-4 codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, […]
OIG Report: $76 Million in Questionable Medicare Payments for Chiropractic Services
The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) recently analyzed Medicare paid claims for chiropractic services from 2013. A major finding: In 2013, $76 million in Medicare payments for chiropractic services were questionable, with Medicare inappropriately paying $21 million for chiropractic services that lacked a primary diagnosis covered […]
2016 CPT Gastroenterology Coding Sheets: Colonoscopy and ERCP
The American Society for Gastrointestinal Endoscopy (ASGE) has published two new coding sheets in order to assist practices in understanding and implementing GI-specific coding. As ASGE notes, the purpose of the coding sheet is to “provide a high level overview to support practices as they prepare for 2016.” Coding sheets are available for: Colonoscopy (CPT […]
Register for Tomorrow’s Clinical Diagnostic Laboratory Test Payment System National Provider Call
The Centers for Medicare & Medicaid Services (CMS) is hosting a free MLN Connects National Provider Call that will discuss the Clinical Diagnostic Laboratory Test Payment System proposed rule on November 10 from 2:00-3:00 p.m. Eastern. The proposed rule — CMS-1621-P — would significantly revise the Medicare payment system for clinical diagnostic laboratory tests and […]
CMS Denies 10% of ICD-10 Claims
The Centers for Medicare & Medicaid Services (CMS) has announced it rejected 10.1% of Medicare fee-for-service claims submitted October 1-27, 2015, with the new ICD-10 codes. On October 1, 2015, health systems transitioned to ICD-10. Between October 1-27, CMS processed 4.6 million claims per day, a similar figure as compared to its historical baseline. It […]
Chiropractors: Check Out These ICD-10 Myths and Facts
The American Chiropractic Association has published a new infographic focused in ICD-10 myths. The infographic, which can be viewed by clicking here, shares several myths, including: Doctors should not waste time on ICD-10 implementation. A bill, if passed, would allow for a transition period of “dual reporting,” allowing organizations to bill both ICD-9 and ICD-10 […]
Medicare Identifies Improper Payments Associated With Extracorporeal Shock Wave Lithotripsy
Medicare has disclosed the primary cause for improper payments associated with extracorporeal shock wave lithotripsy (ESWL). This is according to a recent issue of Medicare Quarterly Provider Compliance Newsletter (pdf), a newsletter from CMS developed to help providers understand the major findings identified by Medicare administrative contractors, recovery auditors and other governmental organizations, such as […]
What is Revenue Cycle Management?
PGM Billing provides a number of services to physician practices, ambulatory surgery centers, labs and other providers. One of these services is revenue cycle management, or RCM. When organizations ask what PGM can do for them and we mention our extensive experience with providing revenue cycle management services, it’s not unusual to hear the question, […]