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HHS releases HIPAA ‘mega rule’; finalizes HITECH Act changes

01/18/2013

Providers will have to give patients electronic copies of their health information and use “a more objective standard” to determine whether patients were harmed by breaches under the so-called HIPAA mega-rule released Jan. 17.

Choose established patients, friendly hospitals to earn new revenue with TCM codes

01/18/2013

by: Roy Edroso

If you want to earn the up to $230 now available for transitional care management (TCM), get cozy with your hospital partners, be prepared for extra work and start with your existing patients.

First PQRS GPRO deadline looms for large practices to avoid at least 1% cut

01/18/2013

by: Karen Long

Practices with 100 or more eligible professionals risk a 1% pay cut because of the value-based payment modifier if they don’t self-nominate to use the group practice reporting option (GPRO) for the physician quality reporting system (PQRS).

Practices may face more overpayments as CMS shares claims data with private payers

01/18/2013

by: Marla Durben Hirsch

You may have more overpayments to give back to your private payers now that CMS has a new partnership with commercial payers to share Medicare and Medicaid claims data to ferret out fraud.

Inaccurate coding of surgical prep of acute wounds means lost reimbursement

01/18/2013

by: Laura Evans

If your practice uses the surgical debridement codes (11042-11047) every time a physician surgically removes tissue for a wound debridement case regardless of intention, your incorrect coding shortchanges your pay and sets you up for unnecessary denials, experts say.

CMS changes modifier 24 rules: E/Ms now bundled with 0-, 10-day global codes

01/18/2013

by: Laura Evans and Julia Kyles

You may have fewer opportunities to get paid separately for E/Ms done on the same visits as minor procedures, those with zero- or 10-day global periods, thanks to the latest changes in the National Correct Coding Initiative (CCI) Policy Manual.

Benchmark of the Week: Top denied preventive services, 2011 vs. 2010

01/18/2013

This graph compares the top 10 most-utilized preventive services that saw the highest denial rates from 2010 and 2011, based on an analysis of CMS claims data.

Your TCM questions answered

01/18/2013

by: Roy Edroso

Your peers at practices across the country have asked questions about TCM on Part B News’ listserv. Here are some answers.

Small practices: Decide whether reporting with GPRO is worth your time

01/18/2013

by: Karen Long

Practices of two or more providers can use the group practice reporting option (GPRO) for the physician quality reporting system (PQRS). But only individual measures are approved for the 2013 GPRO program; practices cannot report measures groups under GPRO.

Part B News brief

01/18/2013

News for certain providers in California.

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