Survive widespread audits of total joint replacement claims by bolstering documentation of each patient’s previously unsuccessful treatments that lead to the surgery, and make sure those notes are in the hospital’s records. One Medicare administrative contractor (MAC), TrailBlazer, denied almost 74% of a sample of claims worth $5.2 million for DRG 470 (Major joint replacement or reattachment of lower extremity without major complication/comorbidity) between July 2010 and March 2011.

Do a better job coordinating care and being accessible to patients, then pocket $20 per Medicare patient every month. That’s the deal that 500 primary care practices have signed on with as part of CMS’ Comprehensive Primary Care Initiative (CPC), a pilot program produced by the agency’s new Center for Innovation.

These charts show the number of annual wellness visit (AWV) codes billed per specialty in 2011, the first year CMS covered wellness visits. The utilizations of two AWV codes – G0438 (initial visit, $166.44) and G0439 (subsequent visit, $110.96) – are charted side by side for each specialty. All numbers come from a Part B News analysis of 2011 Medicare claims data.

Does CMS pay for 0276T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe) and 0277T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes)?

The stage 2 meaningful use final rule makes it official that the second phase of attestation for electronic health records (EHR) incentive payments will begin no sooner than 2014. CMS also finalized that eligible providers (EPs) must register and attest for stage 1 meaningful use by Oct. 1, 2014, to avoid a penalty in 2015.  

Ask key questions of your practice management software vendor now to find out whether you can take advantage of a just-released final interim rule on electronic funds transfer (EFT) and electronic remittance advice (ERA). The rule, effective Jan. 1, 2014, forces payers to remove barriers and inconsistencies that cause you major EFT and ERA transaction headaches.

Eliminate days or even weeks of time it takes your providers to enroll with Medicare by uploading supporting documents to the Provider Enrollment Chain Ownership System (PECOS) website rather than sending paper copies by mail. CMS went live with this latest PECOS upgrade this month and has instructed all Medicare administrative contractors (MACs) to accept supporting documentation online.

Clustering levels of E/M services is not new but continues to be a hot topic for CMS and the HHS Office of Inspector General (OIG). Clustering means billing all of your E/M services among one or two middle-level E/M services because you reason that some will be higher and some lower and the payments will average out in the long run -- that raises two big problems for you.

Codes with similar descriptions for care plan oversight 99374-99380, physician supervision of home health services and non-face-to-face physician services 99441-99444 can make billing proper codes confusing.This chart simplifies the process of choosing the right code by breaking it down by where the patient lives, who the payer is, how much time is involved and what services the doctor performs.

These charts show the latest trends in inpatient versus outpatient services billed to Medicare per specialty, comparing 2010 ratios with 2006. All percentages come from a Part B News analysis of the latest Medicare claims data available. Inpatient services are defined as those that were billed with place of service (POS) codes 21 (inpatient hospital) or 23 (emergency room) and outpatient services were billed with POS codes 11 (office) or 22 (outpatient hospital). Note: The percentage figures refer to the share of all utilization for each specialty in a given POS. For example, cardiologists in 2010 billed 24.7% of Medicare services using POS codes 21 and 23 and 75.3% with POS codes 11 and 22.