You must have an action plan ready in case contract negotiations with your payer sour before an agreement can be made. But first you must recognize the signs negotiations are going badly, so you can to get the talks back on track before you give up, experts say. You must understand why a payer won’t negotiate. It could be a lack of money, a belief that your network is flush with providers and fair rates or the payer is not interested in cooperating.

Recovery Auditor Contractors (RACs) are reviewing physician claims, recouping payments and making mistakes that could result in practices handing over money they should have kept. RAC audits and errors are a growing problem for physicians, which means you'll have to police your RAC and be ready to state your case when it doesn’t follow Medicare’s payment rules.

The following code crosswalk, developed by Regan Tyler, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services shows you how the 2011 skin substitute codes crosswalk to the new 2012 codes. Note that codes with * previously were not broken out by anatomical location, so for the new codes, you will need to select the appropriate code based on location as with the other graft codes (see table below for assistance).

Don’t be surprised to have to meet Medicare and Medicaid’s meaningful use requirements even when you deal with private payers. But it’s only adding to the confusion – more of them are adopting the federal government’s meaningful use criteria as a part of their own quality incentive programs – but in addition to, not in replacement of, other pay-for-performance criteria.

Overall losses from denials per practice continues to rise. Seven of the 10 specialty types listed below suffered more denial dollars per provider in 2010 than they did in 2009. However, one of the three groups that improved, medical specialties, did see one of the most dramatic year-over-year differences out of the 10 groups, with a 20% decline from 2009 to 2010. NOTE: The cost of denials per provider is an average, calculated by dividing the total amount of denials paid per specialty by the number of providers enrolled in each specialty. NOTE: The data labels at the top of each set of bars below signify the difference in denial amount per provider from 2009 to 2010.

Our physicians provide annual wellness visits (AWV) and bill either 99397 (periodic comprehensive preventive medicine re-E/M of an established patient) or E/M visits, 99212-99215, in addition to the AWV especially if the patient has a current issue or needs follow up on a chronic disease. The providers distinguish between the annual physical (99397) and a preventive exam, such as the AWV, as separately billable. Is this correct? Also, can you bill for an annual physical (99397) and an AWV if the patient’s secondary insurance covers the 99397?