You have less than two months until your private payers and CMS stop accepting non-compliant HIPAA 5010 claims. Maintain cash flow and prove your practice is 5010-ready by the June 30 enforcement deadline with documented communication from your payers and clearinghouses.

Rather than wait for ICD-10 to make documentation enhancements vital for the new code set, start those changes now to improve your practice’s private payer reimbursements.

Private payer contracts are changing to reflect the severity of your patients in two key ways:

Auditors love to go after E/M services for a few reasons. First, as you probably know, payers spend the most on these services and they are billed in huge volumes, making it easy to establish patterns. Since code selection is so subjective, E/M services are an easy target to recoup because it’s harder for you to prove your code selection.

Find opportunities to increase your practice’s efficiency through a consistently monitored benchmark dashboard that allows you to compare your performance against your specialty. The metrics you include in a benchmark dashboard will vary based on specialty and your personal preferences, but it’s vital that you have accurate in-house numbers to see where you have room for improvement, says David Zetter of Zetter Healthcare Management Consultants in Mechanicsburg, Pa.

Primary care Medicaid reimbursements stand to receive a significant boost from a CMS proposed rule that would match in 2013 and 2014 the Medicare physician fee schedule rates for Medicaid patients. The federal government would be required to foot the bill on whatever the difference is between the Medicare rate and each state’s Medicaid rate.

This chart shows 10 preventive services that saw the highest denial rates in 2010 along with those services’ 2009 denial rates, based on CMS claims data. Note: Where multiple codes were chosen to represent the same service, the average denial rate is shown.

Does CMS’ new place-of-service (POS) rule affect the date-of-service (DOS) rule as well? For example, when Virginia was under the Medicare administrative contractor (MAC) TrailBlazer, CMS announced that the DOS for professional components of diagnostic tests should be the date the physician interpreted the study but not the date of the test.