The proposed 2013 Medicare physician fee schedule is a departure from recent rules in that it contains a plethora of policy information.

“If I had looked at a proposed [fee schedule] eight years ago, there would have been more issues about coding, and this rule is really about policy and where Medicare wants to move in the future,” says Betsy Nicoletti, CPC, consultant with Medical Practice Consulting in Springfield, Vt.

Track your payment changes for imaging services and office visits from 2009 through 2012 and your prospective payments for next year based on the proposed 2013 Medicare physician fee schedule. Note: Reimbursement rates for 2013 services were calculated using the 2012 conversion factor and do not reflect the rates for the actual conversion factor to be finalized by Congress for 2013.

How do you code encounters for patients with a severe upper respiratory infection and impacted cerumen who were prescribed an antibiotic injection and had the earwax removed?

Primary care physicians could get a 7% pay increase and other providers could see bumps between 3% and 5% in 2013, according to the proposed 2013 Medicare physician fee schedule released Friday. But that pay raise may prove moot if Congress doesn’t stop the 27% sustainable growth rate (SGR) cut set to hit payments Jan. 1.

In a surprise decision, the Supreme Court has upheld almost all of the Patient Protection and Affordable Care Act (ACA), opening the pathway for more patients to flood your office with appointments. The individual mandate, which guarantees health insurance to virtually every U.S. citizen, has been held constitutional as a tax levied by the federal government.

Your practice may be losing thousands of dollars because of low reimbursement rates from private payer fee schedules. Ask your payers for complete fee schedules every year to avoid falling in that trap. Without seeing the fee schedule, practices can’t make educated decisions as to whether the “updated” rates are higher or lower than before.

Physicians will check a box labeled “all others negative,” intending to indicate that the patient had no other complaints so other systems were not reviewed. But that type of checkbox indicates that the physician did review the rest of the systems, overstating in the documentation the work the doctor actually did, says Regan Tyler, CPC, senior consultant for DecisionHealth Professional Services.

If you aren’t scheduling annual wellness visits (AWVs) for your Medicare patients, you’re not only missing out on revenue for those visits but also losing a perfect opportunity to schedule future visits for five reimbursable preventive services.

The questions physicians or non-physician practitioners (NPPs) ask during AWVs inform them which patients are applicable for screenings at separate visits. That makes it simple to schedule the screenings for multiple patients.

Your revenue is at risk with Medicare poised to automatically filter claims for errors related to new versus established patients. Too many mistakes could look like abusive billing or intentional ignorance about coding rules.

New patient visits pay more than established visits of the same level, but if you bill a new patient with a lower-paying established patient code, you’ll miss out on revenue you’re owed.

This chart shows the volume of Medicare claims billed by physicians who billed the most and least often, defined by the average number of claims billed per provider within that specialty. Example: The average cardiologist billed 5,053 Medicare claims in 2010. Note: The first seven specialties had the highest Medicare volume in 2010, while the last seven specialties had the lowest volume. Note: These figures were calculated by dividing the total number of services billed by all providers in a specialty into the number of individual physicians enrolled in each specialty, according to Medicare claims and provider enrollment data from 2010.