Surgeons could see both payment and post-op patient volume drop under CMS’ proposed reconstruction of relative value units (RVUs) for the E/M portion of surgical procedures with a global period. But despite possible revenue loss, surgeons pack in more billable patient visits and procedures with slashed post-op E/Ms.

Assess payments you receive from pharmaceutical and medical device manufacturers for research, presentations, testing and other services and whether you’re comfortable with that information being posted on the Internet. The Sunshine Act, which is part of the Affordable Care Act (ACA), requires certain pharmaceutical, biologic and medical device makers to track and annually report to the HHS payments or other “transfers of value” they give to physicians and teaching hospitals.

The problem: Physicians use of template language, “old review of systems [ROS] updated,” on all charts when such an update was not documented correctly or completed for every patient. For example, a doctor refers to her review and changes of a previous visit’s ROS and PFSH in the current note by writing, “ROS from Jan. 5 reviewed and updated.” But the Jan. 5 note does not have the required doctor’s signature and current date on it, says Regan Tyler, senior consultant for DecisionHealth Professional Services.

Physicians transitioning to Novitas Solutions need to provide a new electronic funds transfer (EFT) authorization agreement. Practices that had used EFT with Pinnacle Business Solutions, Cahaba GBA and TrailBlazer Enterprises could see payment disruptions if they don’t submit new EFT authorization agreements using the CMS-588 form. Those providers received letters between May 15 and July 27, depending on their location, from Medicare administrative contractor (MAC) Novitas asking them to complete and return the form.

Now that the Supreme Court upheld the Affordable Care Act last month, physician practices are beginning to form their impressions and either responding accordingly, or not at all. These charts, based on 136 responses to a Part B News survey conducted late last month, depict answers to two questions, both of which allowed respondents to check off all answers that are applicable: What part of the ACA affects your practice and how have regulatory provisions of the health care law (including revalidation and the 60-day overpayment rule) affected your practice?

What is the correct date of service to use for the professional component (-26) of an X-ray? Should it be the actual date the provider read the film or the date the film was taken?

Find an accountable care organization (ACO) that allows your physicians to maintain autonomy or you might wind up making dramatic changes without receiving the desired savings, experts say.  Whether you like it or not, ACOs and other new payment models represent the future of Medicare as it gradually shifts from volume-based to performance-based payment. 

Practices that refill and order durable medical equipment (DME) for patients will have more paperwork to complete and send to suppliers if CMS finalizes its proposal in the 2013 Medicare physician fee schedule. Non-physician practitioners (NPPs) can conduct the face-to-face visit, the order won’t get approved without a doctor’s sign-off.

Familiarize yourself with the Physician Quality Reporting System (PQRS) in the second half of 2012 to prepare for 2013 reporting and avoid the 1.5% penalty in 2015 based on 2013 data. You’ll also receive a 0.5% Medicare payment increase for successfully reporting in 2013 and 2014.

The biggest concern in a recently released HHS Office of Inspector General (OIG) report on Medicare E/M coding trends – finding that certain physicians consistently bill higher E/M levels than their peers – is that it mirrors what we see in client audits all the time.