Your practice will soon have one more good reason to make sure you get the patient to sign an advance beneficiary notice (ABN) if you think a claim doesn’t meet your carrier’s medical necessity requirements. Starting July 1, CMS has given its contractors discretion to auto-deny claims that arrive with the GZ modifier, which indicates that the claim may not meet medical necessity rules and that the patient did not sign an ABN.

Your biggest long-term worry – that your Medicare payments are perpetually balanced on a razor’s edge, at the annual mercy of the mood in Congress – is shared by the Medicare Payment Advisory Commission (MedPAC), which spent its latest meeting discussing ways to end this problem.

This chart compares current stage 1 meaningful use requirements to the very early, stage 2 meaningful use requirements, which were released Jan. 28. The stage 2 requirements are a draft, released as a request for information (RFI) by the HHS Office of the National Coordinator for Health Information Technology (ONC).

These charts examine trends in utilization and denial for laboratory services paid by Medicare from 2008 to 2009. The percent values above the bars refer to the change in denial rates and utilization, respectively, from 2008 to 2009. Denial rates have fallen for most of these high-use services, but they remain extremely high for blood glucose test 82948 and fecal occult blood test 82270, which were billed more than 500,000 and 1.3 million times respectively in 2009.

An opportunity to be paid for MRIs done on patients with implanted defibrillators, plus CMS posts a sample form for private payers to use when considering premium increases of 10% or greater.

What are the documentation guidelines for when a physician admits a patient to observation status and then the next day the same patient is admitted and seen as an inpatient?  Would the physician have to dictate a separate report for the physician’s chart (in office) for this or can the physician just note this on the progress note at the hospital?