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Provider payments ‘fixed’ in fiscal cliff deal

01/07/2013

Your Medicare payments are safe for another year from the ever-looming sustainable growth rate (SGR) cut. Congress’ “fiscal cliff” agreement — brokered and passed by the House and Senate on Jan. 1 — prevented the 26.5% SGR cut from going into effect as part of a larger legislative effort that also extended certain tax benefits.

PBN’s 2013 predictions: PQRS, e-Rx, ICD-10, Medicare uncertainty concerns

01/07/2013

by: Karen Long

The New Year will bring more Medicare reimbursement uncertainty, more providers jumping on the physician quality reporting system (PQRS) and e-prescribing (e-Rx) bandwagons and an earnest start to ICD-10 preparations at many practices, experts predict.

3 ways to secure payments with claims corrections, stand up to payer scrutiny

01/07/2013

by: Karen Long

This scenario often plays out at practices: A payer asks for documentation to support a claim. When reviewing the chart before sending it, the practice staffer notices some information missing. How the provider amends or corrects the documentation means the difference between a payment and a denial.

Q1 drug prices face slight decrease overall with few bright spots

01/07/2013

by: Roy Edroso

Expect relatively flat drug prices in the first quarter of 2013, with a few exceptions, and slightly lower prices overall for your most-billed drugs.

CMS released its 2013 first-quarter average sales price (ASP) list, effective Jan. 1. The list includes 569 drug codes, about 45% of which will see a pay raise compared to 2012’s fourth quarter changes.

Benchmark of the Week: 10 highest and lowest modifier denials, 2010-2011

01/07/2013

by: Ben Penn

These charts examine a total of 20 modifiers, 10 of which had some of the highest denial rates in 2011 and 10 which had some of the lowest, comparing their 2011 rates with 2010. Modifiers with a total service count of less than 100,000 were excluded from the graphs, which were based on a Part B News analysis of the latest Medicare claims data available.

You asked, we get answers to your top Medicare enrollment questions

01/07/2013

by: Ben Penn

Don’t assume the online Provider Enrollment, Chain and Ownership System (PECOS) process is too complicated and you’re better off enrolling on paper. PECOS has undergone a facelift that eases the process, but you have to learn some basics to take advantage of the new features.

PBN’s 2012 predictions: Right about 5010, ACA; wrong about ICD-10

01/07/2013

by: Karen Long

As we start 2013, here’s a look at how clear — or cloudy — the Part B News crystal ball was with its
2012 predictions.

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