If you already have an electronic health record (EHR) and participate in the Medicare Physician Quality Reporting Initiative (PQRI), reporting may get easier and become a more accurate depiction of actual care next year, as CMS is considering expanding the program to include clinical data reported from EHRs.

Getting a piece of the federal stimulus money for adopting electronic health records (EHRs) may have just gotten a little bit easier. But you are not in the clear yet. The second draft of a definition for "meaningful use" of health IT to qualify for stimulus funding, published in July, proposes to loosen some of the original standards and open up the certification process to some competition.

You've probably heard it before - the switch from paper to electronic medical records will hit small practices the hardest. Systems are too complex, some say. Another argument is that small practices don't have the resources - and still won't even if they get the financing for EMRs to help them qualify for tens of thousands of dollars per physician in federal Medicare or Medicaid subsidies starting in 2011. There's the fear that an initial slowdown in patient volume often caused by installation of EMR would cripple business.

Be proactive and tighten up your internal review process when the permanent recovery audit contractor (RAC) program begins. Expect to deal with not only your regional RAC, but also more aggressive reviews from your current carrier or Medicare Administrative Contractor (MAC), experts say (see story, here).

Most practices continue to accept all new Medicare patients, and specialists accept them at higher rates than primary care doctors despite continued stagnation in payments and the threat of pay cuts, according to cumulative surveys of physicians by the Center for Studying Health System Change (HSC). The bold percentages above the bars show the average acceptance rate for each amount of new patients. Specialists are more likely to accept new patients as they are often referred on a case-specific basis and don't stay in the practice, as a patient does with a primary practitioner.

Question: I'm trying to pin down Medicare's rules for 45378 (Diagnostic colonoscopy, $368.96) vs. G0121 (low risk screening colonoscopy, $368.96). A physician listed rectal bleeding as the primary diagnosis, but he states the procedure performed was a "screening colonoscopy." If coverage limitations are met and there aren't any other findings, how should we report it? It's my understanding that a screening is only indicated when the patient presents without any symptoms.

Update your practice's security plan for health information security breaches today. Your practice will need to take extra steps to prevent and mitigate breaches under a new law set to take effect next year. The American Recovery and Reinvestment Act (ARRA), known as the 2009 stimulus bill, provides you with a better definition for what constitutes a breach of patient health information. At the same time, the act increases penalties for when a breach occurs in your office.

Here are the official CMS definitions and codes for three places of service mentioned in a recent HHS Office of Inspector General (OIG) report. Keep this information handy to clear up any confusion over where a service was provided.

Licenses and a facility cost report will show which buildings and offices are owned and operated by a hospital, ambulatory surgery center (ASC), or outpatient facility. Checking these sources will help you determine the correct place of service when your billing department is ever unsure where a service actually took place. The HHS Office of Inspector General (OIG) found several cases where the location of a physician's office was incorrectly reported on claims, and now estimates physician practices have been overpaid $20 million over two years, according to a recent report. Expect the government to want that money back.