Don’t let poor documentation of hospital-based cardiology services put you in the crosshairs of a hospital audit and force you to pay back thousands of dollars in improper payments. Secure revenue by justifying medical necessity for all diagnostic tests and procedures performed and by keeping up with hospital records.

Expect to close the year with minor pay changes overall for your most frequently billed drug codes. CMS leveled out its adjustments for 2012’s fourth quarter average sales price (ASP) list, effective Oct. 1, by giving pay bumps to about 40% of the listed drug codes. Drug prices for the fourth quarter averaged a 1.7% pay cut but remain relatively stable in comparison with previous quarters, CMS says in its ASP report.

Physician practices are currently operating in a transition period, with many trying to answer key questions about their futures while being plagued by financial and regulatory uncertainty. What happens when the tougher questions come up as we move toward implementation of health reform in 2014, which is likely to mean more patients in the system and a push for you to work with hospitals, integrated health systems and other provider types?

Look for “practical tools,” such as checklists and decision trees, from CMS to prepare for ICD-10 implementation in 2014.

CMS also plans to hold an ICD-10 provider call Oct. 25 aimed at preparing physicians for the new code set.

Providers will have to wait until the end of that week for accurate data on patients’ therapy use, said George Mills, director of CMS’ provider compliance group, during a Sept. 26 call.

This chart depicts the utilization rate of established office visit code 99215for the 15 specialties that billed the code most often in 2010. Based on a Part B News analysis of Medicare claims data from 2010, 2006 and 2001, the graph compares the three years’ utilization rates for each specialty.

When a peripherally inserted central catheter (PICC) line is placed, it is standard practice to do a chest X-ray to confirm placement. Is it appropriate to bill for the chest X-ray in addition to the PICC line insertion?