Be prepared to bill patients directly for an even greater share of your claims. Patients who will pay for their care because they haven’t hit the deductibles of high-deductible health plans (HDHPs) are shifting how practices go after collections. Practices used to “pound on” insurance companies for payments. “Now it’s the patient. You need more savvy staff at the front desk,” explains Doral Davis-Jacobsen, manager of health care consulting, Dixon Hughes Goodman, Asheville, N.C.

These charts present payer performance based on two key determinants – amount of time it takes to send first payment and the percentage of claim lines paid $0 for any reason. Payer timeliness is broken down by time ranges of zero to 15 days, 16 to 30 days and 31 to 45 days. For the second chart, the claim lines were paid $0 for such reasons as denials, claim edits and patient responsibility.

Can you add modifier 59 (Distinct procedural service) to a physical therapy re-evaluation (97002) to unbundle it from another treatment given the same day, such as 97110? 

CMS’ proposed 2013 Medicare physician fee schedule boasts several changes, chief of which are new measures for the Physician Quality Reporting System (PQRS) program. Download Part B News’ tool detailing all 13 proposed quality measures via the “Download file” link. 

The estimated 7% increase to primary care payments included in the proposed 2013 Medicare physician fee schedule is based mostly on a new G-code for post-discharge transitional care management. Additional work is required to use the code, but you would also get extra money for services physicians already provide.

Cardiologists, ophthalmologists and group practices face sharp pay cuts for reading imaging tests as CMS pushes further expansion of the multiple procedure payment reduction (MPPR) initiative in its 2013 proposed physician fee schedule. CMS proposes to reduce rates for the technical component (TC) of diagnostic services – previously untouched by the MPPR.

Practices with two to 24 providers would have the option of an easier way to report Physician Quality Reporting System (PQRS) measures next year through the group practice reporting option (GPRO). In its 2013 proposed physician fee schedule, CMS would expand the definition of group practice, previously characterized as a practice with 25 or more providers, to increase participation.

Online exclusive: You’ll have a tougher time getting paid for preventive services, such as alcohol screening, now that CMS has bundled several screening services with office visits in its National Correct Coding Initiative (CCI) edits that were effective July 1.

If your practice participates in the EHR incentive program, you might be able to get an exemption from e-prescribing (e-Rx) penalties.CMS proposes two new significant hardship exemption categories for 2013 and 2014.

Based on their performance in 2013, practices with 25 or more providers would be subject to a 1% payment penalty or an unspecified bonus in 2015 from CMS’ value-based payment modifier, an Affordable Care Act reform that would apply to all practices in 2017.

The payment modifier, aligned closely to the Physician Quality Reporting System (PQRS), has been called a potential “game-changer” by the Medical Group Management Association because it will pay practices based on the quality of care compared with cost.