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10/14/2010

I have a two doctor OB/GYN clinic that also performs GYN surgery. If the patient needs a hysterectomy (58270) and urinary suspension (sling) repair (57288), one doctor will do the hysterectomy and the other will assist him. Then the other doctor will do the sling with the first doctor assisting. Both doctors are able to do both surgeries, but they split this up to gain more reimbursement (around $350.00). Is this compliant? We're getting paid by Medicare and other payers, but I feel that it is wrong.

10/14/2010

You and your peers beefed up use of modifier 8P during the 2009 Physician Quality Reporting Initiative (PQRI) program year. A Part B News analysis of CMS billing data shows a substantial increase of utilization of 8P (reason not otherwise specified) compared to the previous reporting year.

10/14/2010

This chart shows how Medicare utilization of top imaging services has shifted by specialty from 2008 to 2009. Each "pie" represents all imaging services billed to Medicare in a given year. NOTE: Diagnostic radiology and interventional radiology were excluded from the pie, because while their utilization has fallen steadily, it's still large enough to overwhelm the chart (they accounted for 95.7% of imaging utilization in both 2008 and 2009).

10/14/2010

You now know how much CMS will pay you for seasonal flu vaccines. Here is a list of influenza vaccine prices for this flu season.

10/14/2010

You and your peers have not been able to bill Medicare for consults for nearly a year, but confusion remains over certain scenarios that involve whether to use new or established visit codes for some inpatient services. The fact that many patients receive a combination of Medicare and private coverage has also helped prolong uncertainty, experts say.

10/14/2010

You'll benefit most from regional extension centers (RECs) if you're a small primary care practice, but many of these federally funded organizations will help specialists adopt electronic health record (EHR) systems as well - for a higher price.

10/14/2010

You will receive special attention from the HHS Office of Inspector General (OIG) starting next year when your claims consistently contain errors (PBN 10/11/10). After conducting a four-year audit, OIG inspectors found a total of 740 Medicare providers they believed to be "error-prone" and deserving of special attention in the form of overpayment demands.

10/14/2010

You and your peers lost more than $610 million in 2009 thanks to unusually high denials on the two lowest-level E/M visits commonly billed by physicians, new CMS data reveals. Established visit codes 99211 ($19.54) and 99212 ($39.84) suffered denial rates of 9.7% and 6.3% respectively in 2009, according to the latest CMS claims data.

10/14/2010

Your path to quality reporting success in 2011 may be smoother based on where you focus your reporting efforts, a Part B News exclusive analysis reveals. Your peers heavily relied on electronic health record (EHR) use, perioperative care and prevention screens when attempting to earn bonuses from the Physician Quality Reporting Initiative (PQRI) in 2009.

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