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PMG Insights Blog posts

November 20, 2020
by Simon Hughes

COVID-19 Vaccine Codes

Updated December 22, 2020: The COVID pandemic has had tremendous emergent impact upon medical care, testing and supplies.  In response, the AMA’s CPT Editorial Panel has had to rapidly create and establish new CPT codes for COVID reporting, tracking and analysis to support data-driven planning and resource allocation. On December 12, 2020, the Pfizer COVID […]

September 21, 2020
by Simon Hughes

Proposed Evaluation and Management Coding Changes for 2021

It has taken 30 years, but the AMA and CMS have performed a complete overhaul of the Evaluation and Management (E/M) documentation and coding guidelines and they are set to be implemented January 1, 2021.  The hope is that the burden associated with meeting the 1995 or 1997 guidelines will finally be lifted and patient […]

August 13, 2020
by Simon Hughes

Changes to Medicare Provider Enrollment Due to COVID-19

The Covid-19 National Health Crisis has impacted Federally Community Health Centers (CHCs) in ways never before seen.  Many are involved in testing and have ramped up their Telehealth process.  However, CHCs across the country are seeing significant declines in patient visits, staff shortages due to exposure and ultimately, a challenging financial landscape. In addition to […]

June 25, 2020
by Simon Hughes

HCPCS CS Modifier Guidelines Related to COVID-19 Testing for Community Health Centers

Updated 8/27/2020 The Family First Coronavirus Response Act (FFCRA), which went into effect March 18, 2020, waives cost-sharing (i.e., coinsurance and deductibles) by patients receiving COVID-19 testing-related services, as well as the testing itself. This Act applies to group and individual health plans including Medicare, Medicare Advantage, Medicaid, CHIP, and private payers. The Coronavirus Aid, […]

June 16, 2020
by Simon Hughes

Coding Guidelines for SARS-CoV-2 (COVID-19)Testing in Health Centers

Updated 12/22/2020 On May 24, 2020 the Department of Health and Human Services presented a COVID-19 Strategic Testing Plan to Congress which describes, among other things;  detailed information on various testing methodologies; medical device and test availability; and, research and advice designed to inform the government as plans for re-opening the country are made and […]

May 1, 2020
by Simon Hughes

Community Health Center Telehealth Services covered by Medicare during the COVID-19 Public Health Emergency – Highlights from the latest Medicare Learning Network

Updated 10/6/2020 On April 17th, CMS released the much anticipated Medicare Learning Network Matter article (SE20016) as guidance for health centers regarding telehealth reimbursement during the COVID-19 and 1135 Waiver Public Health Emergency (hereafter “COVID PHE”). Health centers had been waiting for this directive since March 17th when expanded language around Medicare billing was provided […]

December 19, 2019
by Simon Hughes

FQHC Revenue Cycle Management Best Practices | PMG

By: Ken Christensen, CEO PMG, Inc. I’d like to take this opportunity to offer my perspective on a topic of intense interest to many of our clients: Overlooked Revenue Cycle Optimization Opportunities There are unique challenges facing operators in the community-based setting which can impede optimal revenue cycle performance and impact cash flow.  Through organizational […]

June 10, 2019
by Simon Hughes

FQHC in Southwest on Pace to Add $2MM in Revenue

The Challenge A large Federally Qualified Health Center (FQHC) in the Southwest was concerned about their lack of visibility into claim denials and overall claims activity. This is a common story in the industry; according to a survey conducted at HIMSS19, less than 24% of healthcare executives leverage their data daily. The FQHC’s Chief Financial […]

March 4, 2019
by Simon Hughes

Do You Dread Month End Reporting at Your CHC?

Part 4 in the PMG Series: Key Strategies for your health center By: Robert B Skeffington, PMG Partner and Co-Founder As my colleagues and I travel around the country visiting Community Health Centers (CHCs), a common concern bubbles up: “I hate month end”. We are hearing this more often than in past years and from […]

January 18, 2019
by Simon Hughes

9 Questions to Ask Before Hiring a Revenue Cycle Vendor for Your CHC

In past posts, we explored the pros and cons of outsourcing your center’s revenue cycle/ billing functions. If you have decided to consider outside vendors you must be sure that they are able to handle the job and improve collections at your CHC. Since most revenue cycle/ billing companies don’t tell you they plan on […]