You will need to take the paper records for more than 50% of your patients and convert them to electronic records in your electronic health record (EHR) system, as well as ensure that 40% of your prescription are transmitted electronically in order to get your $18,000 bonus payment under the EHR Incentive Program.

Big changes are coming in 2012 to the way CMS pays Medicare Advantage (MA) plans, which in turn will impact the number of MA patients you see and how much you’ll be paid for seeing them. On average, MA plans will see a 1.6% reimbursement increase in 2012, but this figure will vary based on your region

Expect the reprocessing of claims impacted by passage of the Patient Protection and Affordable Care Act (PPACA) to begin in approximately two weeks, CMS officials announced during a recent conference call. But before you start a daily watch for these funds, note that the agency expects it to take months to re-run the hundreds of millions of claims impacted.

Watch your private payer’s administrative and medical policies for guidance on when you should use preventive services modifier 33. Two payers have already issued instructions for this modifier.

You may see changes in CMS’ e-prescribing incentive programs. The Government Accountability Office (GAO) has criticized the agency for its handling of the two e-prescribing incentive programs it administers, noting that they are inconsistent with each other, create additional burdens on physicians and cause the programs to be less effective.

These charts look at E/M services billed in the office and inpatient settings (place of service codes 11 and 21 respectively) to try and isolate which of three factors has the greatest impact on denials. The factors examined are new vs. established patient, office vs. inpatient setting, and the code level.

How do you determine how many units to bill based on the number of milligrams in a drug? For example, if liquid albuterol comes in 2.5 mg/3 ml for use in the nebulizer and the CMS drug fee schedule says 1 unit. Does that mean that the entire 2.5 mg/3 ml is only equal to 1 unit or does each mg count as a unit?