Being able to give private-insurance patients a specific amount of money owed for a visit and pressing for payment are about to get much easier, as an Affordable Care Act (ACA) reform will require health plans to give you real-time insurance verification within 20 seconds of your request.

Fight back when your employee health insurance company tries to sock you with a large premium hike. If your employees have been relatively healthy, it’s likely the insurance company will reduce its increase. Practices rarely take that tactic, but it can work.

You could see payment delays for claims related to short hospital stays because of a CMS recovery auditors’ (RACs) demonstration program launching Aug. 27. While the RACs will focus first on Part A services, your providers’ claims and documentation may be scrutinized if the services rendered were clinically related to a patient’s short hospital stay, experts say.

Physicians will fill in each element of a history of present illness (HPI), even when some are not applicable, because an electronic health record (EHR) template provides spaces for all of them. The doctors will think they have provided enough information to warrant a certain level of service by completing all eight elements, but that’s not always the case, says Regan Tyler, senior consultant at DecisionHealth Professional Services.

This chart presents the denial rates for initial patient E/M codes (99201-99205) that were appended with modifier25 (separately identifiable E/M service), separated by the place-of-service code. Hospital place-of-service codes – inpatient (21) and emergency room (23) – are grouped together, as are office (11) and outpatient hospital (22). Note: All data were derived from a Part B News analysis of Medicare claims data from 2010, the latest year available. (For a breakdown of the same denial rates, but for established patient visits, check out next week’s Benchmark of the Week.)

HHS released a new set of operating rules that will require health plans to streamline the electronic fund transfer (EFT) and electronic remittance advice (ERA) processes, making it simpler for physician practices and hospitals to take part in those transactions.

What are the documentation requirements for billing CMS’ five new preventive care codes (G0442-G0449)? Is there a time element?