Part B News | Part B News

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

01/07/2013

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.

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

12/24/2012

by: Laura Evans

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.

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