Analyze your surrounding market and patient demand to determine whether expanding your hours to evenings and weekends could lead to more patients and not lost revenue. As more retail health clinics and urgent care centers open, your patients will be less likely to accept the traditional 8 a.m. to 5 p.m., Monday through Friday schedule.

You now have until April 1, 2013, before you have to worry about CMS’ place-of-service (POS) policy, which was slated to take effect Oct. 1.
The delay came as part of a new transmittal published Sept. 28. “This is an update to transmittal 2435, which clarifies how place of service should be coded,” said Christina Ritter, CMS’ director of practitioner services on a Sept. 28 open-door call.

You may be able to recoup some of the expense of offering a patient portal and even earn some revenue from it by charging for online consults or portal access. Portals could make it easier to meet stage 2 meaningful use requirements that at least 5% of patients have access to health information online and message securely with providers.

Practices are split about whether paper forms or the Provider Enrollment Chain and Ownership System (PECOS), CMS’ online enrollment tool, better suits their needs, according to attendees at DecisionHealth’s National Medicare Provider Enrollment Summit 2012. Wellspan Health System uses paper enrollment forms because of the time it takes to collect physician information.

These charts show the utilization rate of each established patient E/M code (99211-99215) in 2011, 2010 and 2009. In this Part B News analysis of the latest Medicare claims data available, utilization rate was derived by taking the total service count in a given year for each code and dividing it by the service count for all five established patient office codes combined.

Can we bill for both a bladder scan (51798) and complicated catheterization (51703)? Our Medicare administrative contractor, Wellmark, says the catheterization is included in the allowance of the bladder scan. But its Improve the Claims Adjudication Process (ICAP) edits policy contradicts that while CMS’ policy does not allow for a complicated catheterization in conjunction with a bladder scan performed in an office setting on the same day. Were they right to deny our claim?

A recently posted recovery auditor (RAC) issue targeting E/M codes, especially established patient office visit code 99215, raises the risk that practices will have to pay back a percentage of all of those claims for the past three years.

CMS approved the audit Sept. 12 for Region C RAC Connolly’s 15 southern states.

Don’t let poor documentation of hospital-based cardiology services put you in the crosshairs of a hospital audit and force you to pay back thousands of dollars in improper payments. Secure revenue by justifying medical necessity for all diagnostic tests and procedures performed and by keeping up with hospital records.

Expect to close the year with minor pay changes overall for your most frequently billed drug codes. CMS leveled out its adjustments for 2012’s fourth quarter average sales price (ASP) list, effective Oct. 1, by giving pay bumps to about 40% of the listed drug codes. Drug prices for the fourth quarter averaged a 1.7% pay cut but remain relatively stable in comparison with previous quarters, CMS says in its ASP report.

Physician practices are currently operating in a transition period, with many trying to answer key questions about their futures while being plagued by financial and regulatory uncertainty. What happens when the tougher questions come up as we move toward implementation of health reform in 2014, which is likely to mean more patients in the system and a push for you to work with hospitals, integrated health systems and other provider types?