Part B News | Part B News

4 carriers now reprocessing wellness visits; some still giving automatic denials

02/14/2011

At least four Medicare Administrative Contractors (MACs) are now reprocessing annual wellness visit (AWV) claims that were wrongfully denied in January, Part B News has learned. A slight majority of your peers report having had no problems billing the services so far; the rest are split between those who have gotten denials and those who haven’t yet billed the service.

CMS: Appealing RAC findings may lead to carrier denials based on unrelated issues

02/14/2011

by: Grant Huang

You may have a successful appeal strategy for a repayment demand from your recovery audit contractor (RAC) only to have your carrier issue post-payment denials for the same claims for different reasons, such as missing signatures, Part B News has learned.

CMS ready to reprocess, pay your 2010 claims reimbursed under old rates

02/14/2011

by: Charles Fiegl

You’re finally going to receive resolution on retroactive changes to the 2010 fee schedule brought on by last year’s health care reform bill. CMS announced it’s ready to reprocess claims paid between Jan. 1, 2010 and April 1, 2010 (PBN 8/5/10).

4 reasons why it’s easier than you think to meet some EHR core measures

02/14/2011

by: Grant Huang

You will find that many of the mandatory meaningful use requirements – dubbed the “core” measures – are easier to accomplish than many providers believe, experts tell Part B News. Remember: To achieve meaningful use and receive $18,000 in per-provider bonuses under the first stage of the Electronic Health Record (EHR) Incentive Program, you must meet all 15 core measures and any five of 10 “menu” measures for a total of 20 measures (PBN 7/8/10).

Tool of the Month: Medical Decision Making Spreadsheet

02/14/2011

by: Charles Fiegl

Download this month’s tool – a Medical Decision Making Spreadsheet brought to you by DecisionHealth Professional Services – to help you accurately determine the correct level of the complexity of the medical decision for an E/M service.

CMS chief ‘committed’ to permanent pay fix; sees major reform as only solution

02/14/2011

by: Grant Huang

Your top long-term concern may be a permanent fix to the next Medicare physician pay cut set for 2012, but even a permanent fix will not be the answer to a payment system that needs fundamental change, according to some of the biggest movers and shakers in the health industry.

Benchmark of the Week: Top utilization changes by specialty, 2008-2009

02/14/2011

by: Grant Huang

These charts show the top 10 specialties with the greatest utilization growth and the most utilization decline from 2008 to 2009. NOTE: The bars show percent utilization change and do not reflect total number of claims billed. NOTE: Specialties that billed fewer than 1 million claims annually were excluded from analysis.

Survey: Wellness visit denials affect almost a third of practices

02/14/2011

by: Grant Huang

While a slight majority of your peers have not seen denials when billing the annual wellness visit (AWV), one in five have not billed the service yet and another 30% have seen denials, according to an unscientific Part B News reader survey. At least four Medicare contractors have admitted to incorrectly denying the service and are now reprocessing affected claims automatically (see related story).

Ask a Part B News Expert: Billing for injections

02/14/2011

Can a physician office bill for an injection administration charge if patient brings in the drug (such as B-12 or risperdol or haldol)?

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