Avoid a reimbursement decline during the transition from being an independent practice to hospital- or health system-owned by training billing and coding staff. Those employees could have to learn a new electronic health records (EHR) system, provide more documentation for audits, get trained on hospital outpatient billing regulations and start reporting to a new office.

The complexity of peripheral vascular (PV) coding leads to high denial rates and risk of improper payments at cardiology practices. Here are four PV coding problems and solutions to ensure your claims are coded, billed and paid correctly:

Choosing a selective code when the documentation isn’t clear.

Your practice is violating CMS policy if your providers don’t handle their own enrollment and re-enrollment.

But CMS is aware that the practice of sharing a physician’s username and password to update his or her information in the Provider Enrollment Chain and Ownership System (PECOS) is happening, said Zabeen Chong, CMS’ information technology and services director, at DecisionHealth’s 2012 National Medicare Provider Enrollment Summit on Oct. 5.

Doctors among those charged in nationwide fraud sweep. The Medicare Fraud Strike Force rounded up 91 people – including doctors, nurses and other health care professionals – in connection with schemes across the country that totaled $429.2 million in false billing, according to a Justice Department press release.

This chart shows the annual wellness visit (AWV) denial rates for the 13 specialties that billed AWVs most frequently in 2011, the first year Medicare allowed practices to bill wellness visits. For each specialty, the overall denial rate is on the left; on the right is the denial rate for AWVs appended with modifier 25 (Separately identifiable E/M service). Note: This data, derived from a Part B News analysis of Medicare claims data, combine the overall service counts and denied service counts of the two AWV codes, G0438 (initial visit) and G0439 (subsequent visit).

Can we bill Medicare for both the professional fee and ambulatory surgery center (ASC) facility fee if the physician performs an abdominal paracentesis in the ASC?