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CMS updates enrollment rules for out-of-state practice locations

11/05/2012

The paperwork burden of enrolling a new out-of-state practice location into Medicare is now reduced thanks to an Oct. 19 CMS transmittal. The enrollment changes, effective Nov. 20, clarify that you don’t need to fill out a separate 855A, B or I form for a new out-of-state location, so long as you meet a list of criteria.

Benchmark of the Week: E/M code selection, primary care vs. specialists

11/05/2012

by: Ben Penn

These charts examine E/M code level selection for new and established visits (99201-99215) from 2010 to 2011, comparing primary care and specialists. Note: The “primary care” specialty shown here uses combined data from family practice, general practice and internal medicine. The “specialists” category represents combined data for 11 specialties that bill the most E/Ms to Medicare: cardiology, dermatology, gastroenterology, hematology and oncology, nephrology, neurology, ophthalmology, orthopedic surgery, pulmonary disease, rheumatology and urology. Note: The percentages above the bars indicate the change in that code level’s share of total E/M utilization for new or established versions of that level from 2010 to 2011.

Ask a Part B News expert: Time statement for inpatient discharge

11/01/2012

Is it necessary to have a time statement of less than 30 minutes in the documentation for an inpatient discharge (99238)?

Part B News survey: Majority of practices support Romney in presidential race

10/29/2012

by: Karen Long

Republican presidential candidate Mitt Romney would reduce the regulatory burden on practices by decreasing government involvement in health care, say supporters in a recent Part B News survey. “The Affordable Care Act [ACA] is not business-friendly,” says one respondent from a multispecialty practice.

Train clinicians to correct electronic cloned-note errors, prevent denials

10/29/2012

by: Ben Penn

Maximize your electronic health record (EHR) note capabilities while avoiding upcoding and recoupment of E/M reimbursements by teaching your clinicians to properly input patient data and by customizing your templates to prevent abuses.

Expand hours with careful cost analysis; take small steps to see profits

10/29/2012

by: Ben Penn

Increase practice revenue by expanding your hours of operation into evenings or weekends, but make sure to budget your break-even point, staff the new hours and market the change to the community.

UHC: Diagnostic cardio tests need preapproval for Medicare Advantage plans

10/29/2012

by: Lauren C. Williams

You must now get preauthorization before rendering certain diagnostic cardiology tests to your UnitedHealthcare (UHC) Medicare Advantage patients. UHC’s new policy, which went into effect Oct. 1, aims to weed out unnecessary diagnostic tests that fail to meet Medicare’s medical necessity standard, the payer says.

CPT issues 7 new vaccine codes, revises 6 others

10/29/2012

by: Laura Evans

You’ll soon have seven new vaccine codes to use, in addition to six revised codes, according to the latest update to the CPT vaccine code list, issued in July by the AMA. All but one of the new codes are awaiting FDA approval, so you can’t bill them yet for payment.

Benchmark of the Week: E/M office visit denial rates, 2009-2011

10/29/2012

by: Ben Penn

The charts below show the past three years’ overall denial rates for each E/M office visit code. The top chart presents the 2009, 2010 and 2011 denial rates from left to right for initial patient codes (99201-99205) while the bottom chart has the same data for established patient codes (99211-99215).

Ask a Part B News expert: Incident-to billing

10/29/2012

Does the doctor have to be in the office suite if a physician assistant (PA) is billing services under that doctor’s national provider identifier (NPI)?

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