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Nerve conduction studies – The more you do, the less you’ll earn in 2013 under CPT changes

12/24/2012

Be ready for a 30% to 60% reduction in reimbursements for nerve conduction studies (NCS) in 2013. Payment for a common service – five NCS and an electromyogram – was $250 in 2012 but will be $138 in 2013 – a 45% reduction.

Plan for months-long delay in receiving higher Medicaid reimbursement in 2013

12/24/2012

by: Karen Long

Primary care practices might have to wait until mid-2013 to see increased Medicaid payments that match Medicare rates. The increase for 2013 and 2014 would more than double payments in some states, such as Montana where Medicaid pays about 40% of Medicare rates.

Case study: How N.Y. ACO controlled spending, set up for increased Medicare pay

12/24/2012

by: Ben Penn

Identify ways to control spending, such as reducing costs per beneficiary by removing unnecessary consults, to avoid the risks and increase your chances for benefits in an accountable care organization (ACO). Crystal Run Healthcare, Middletown, N.Y., launched care coordination reforms in late 2010, leading to CMS approving it as a Medicare Shared Savings Program ACO on April 1.

Secure revenue from new business ventures with OIG advisory opinions

12/24/2012

by: Lauren C. Williams

Protect future revenue from thousands of dollars in sanctions by first seeking an advisory opinion (AO) on the validity of your business ventures from HHS’ Office of Inspector General (OIG). Advisory opinions are official OIG rulings about a particular business arrangement and usually pertain to anti-kickback violations, such as a hospital participating in gain-sharing behavior with surgeons for using cheaper supplies or performing more of a certain procedure.

Benchmark of the Week: Established patient upper-level E/M denial rates by specialty

12/24/2012

by: Ben Penn

These charts show established patient upper-level E/M denial rates from 2010 and 2011, organized by the 12 specialties that bill initial patient E/M office visits most frequently. Based on a Part B News analysis of the latest Medicare claims data available, 99214 denial rates from 2010 and 2011 for each specialty are displayed in the top chart and 99215 denial rates for those years are in the bottom chart. For a look at the same data but for initial patient E/M visits, go to PBN 12/17/12.

Give providers the option of an EHR scribe to increase documentation efficiency

12/24/2012

by: Ben Penn

Offer physicians transitioning to electronic health records (EHR) as many options as possible to accurately and efficiently document notes, including the choice of using a scribe to type the physician’s clinical information into the electronic record. The scribe, typically a medical assistant (MA), allows physicians who are struggling or unwilling to learn the software to focus entirely on patient care.

Part B News briefs: New MSN form, SGR update

12/24/2012

by: Ben Penn

CMS will go live with an easier-to-read redesign of the Medicare Summary Notice (MSN), which patients will be able to access at mymedicare.gov as of Jan. 3.

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