Q1 2023 Newsletter
Hello all!
Well, here we are, nearing the close of the first quarter of 2023. I hope and trust that all is well with you and that this year is off to a great start.
A few reminders and things to bring to your attention:
If you are experiencing technical issues, please contact our IT support team at support@medicalpmrg.com. If they are not able to assist you with your needs, they will help connect you with the right person. This is the fastest and most effective way to address technical issues you’re having in systems related to your service with us.
We are continuing to upgrade the monthly production report. We recently added the net collection ratio statistic. We think that, in conjunction with the aging report and Days in AR data, this gives a very good high-level financial health check of the practice. Look for values above 95% here – and our aim is to be above 99%. If you have report requests, please send them to reports@medicalpmrg.com.
We are looking at doing a major upgrade to our call center technology so that we can better serve your patients by cutting down wait times and giving them additional options to be in touch with us. I’ve just begun evaluating solutions and hope to have something in place by mid-summer.
If something is not being handled to your satisfaction by any division in our company, please reach out to me! My number one priority is ensuring that you and your practice are taken care of and that you have a seamless relationship with our team.
We at PMRG are excited about 2023. We continue to get better at working remotely—our new permanent state of affairs—and finally feel as though, at least from a work perspective, we have the past almost three years of COVID behind us.
Thanks for your trust in us.
Curt Hill, CEO
The Practice Management Resource Group
The Importance of Understanding CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)
How many times have you, as a provider, received a denial from Medicare because a service you have furnished to a patient is not covered or does not meet coverage criteria? Or had that service deemed “experimental”? It is important to know what policy is in place for a service you furnish to a patient to ensure proper reimbursement from Medicare.
National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) are created by the Centers for Medicare & Medicaid Services (CMS.) They apply to all Medicare providers to establish how a service will be covered; what criteria is required to establish medical necessity; and what documentation requirements there are for the service.
NCDs:
Establish and communicate medical necessity guidelines
Promote understanding for proper billing of claims
Assure conformity
Help eliminate and/or identify potential problems or errors
Decrease appeals
Reduce audit errors
Local Coverage Determination Policies are established by local contractors and only apply to certain Medicare Administrative Contractors (MACs).
LCDs:
LCDs created by MACs
Local contractor level
Contractor Medical Directors’ (CMD’s) responsibility
May or may not be associated with NCD
Assist in determining reasonable and necessary criteria
LCDs cannot restrict or conflict with NCDs or any CMS interpretive manuals
Not all services have a policy
Contain reasonable and necessary language
Provide coverage guidance
Include documentation requirements to support medical necessity
Local Coverage Articles (LCAs) are additional documentation that accompany an LCD that will outline the billing guidelines associated with the LCD. LCAs give guidance on what CPT codes the LCD covers as well as what diagnosis codes (ICD-10 codes) support the medical necessity of the procedure. Always read both the LCD and LCA to determine if the diagnosis you are treating supports the medical necessity of the procedure you need to perform.
Locating a coverage policy prior to performing a service for a patient can mean the difference between getting paid and not getting paid for the service you furnish.
Acquaint yourself with your region’s Medicare Administrative Contractor website. Each MACs website will have a section available to search for LCDs. It will allow key words or CPT codes to search.
We at PMRG are working hard to communicate the proper coding and billing guidelines with our clients to ensure you are reimbursed for the hard work you do. If you have any questions regarding Medicare coverage criteria, LCDs or LCAs, please reach out to Jana Holt at jholt@medicalpmrg.com.
Meet the Staff: Corinne Hendershot
This month we’re excited to introduce you to Corinne Hendershot. Corinne has worked at PMRG for more than 10 years and is currently a team lead for ophthalmology groups based in San Francisco.
From the beginning, Corinne has been an exceptional employee. She started at PMRG doing an externship while attending a medical insurance billing and coding program at Everest College-Merrionette Park in Illinois, which she did while helping to support her family of six children by working at a nightclub and caring for both her sick father and grandmother. Corinne was recognized for her hard work and perseverance when she received the college’s Dream Award for overcoming extraordinary challenges while completing a post-secondary program. Despite her many challenges, Corinne graduated as valedictorian of her class with a 4.0 and perfect attendance. Her extraordinary work ethic also led to an offer to work at PMRG, where we’ve been grateful to have her ever since.
Corinne enjoys working at PMRG as much as we enjoy having her.
“The management is supportive and encouraging,” Corinne says. “I’ve never worked for any other company that was so invested in making sure their employees are in a healthy spot, mentally and physically. They are also very family oriented. Everyone that I have been in contact with at PMRG is also very supportive in helping across the company.”
In addition to being a stellar employee, Corinne is committed to her family: Daniel Hendershot Sr., her husband of 17 years, and her six children, ages 20 to 11: Destinee, Evin, Domenic, Daniel Jr., David and Melodee. She and her family travel back and forth between Illinois and Indiana—where they live now—as much as they can to see extended family.
