This week’s question is answered by Regan Tyler, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services.

Q: A patient comes in for a spinal injection. On that same day, the patient is evaluated before the procedure to determine that it is appropriate for the patient, which may differ from what is requested from the ordering physician. Can you bill for an office visit as well as the procedure since a medical examination is done prior to it?

You now have an extra 30 days to get ready for the HIPAA 5010 transition regardless of whether you’ve successfully tested your claims by December 31, CMS announced in a MLN Matters article on Dec. 14. Providers who haven’t tested 5010 claims can send 4010 claims after Jan. 1, 2012 but only after submitting a transition plan to CMS in the next 30 days.

As much as you want 100% upfront copay collections, the reality is you will always have exceptions. Prepare different reactions to each of these situations – all with careful documentation – with a protocol for attempting to either collect at a later date, help the patient qualify for a copay exemption or discharge the patient if necessary. The first variable you must consider once you are certain a patient cannot pay upfront is the severity of the patient’s condition.

You can increase your revenue and boost your reputation in your area by regularly adding new patients to your roster. But you must develop a proactive public relations campaign to get the word out about your practice. Your best recruiting tool is word of mouth so you must get involved with your community, says Mike Robertson, practice manager for Internal Medicine of Southeastern Indiana in Batesville, Ind.

You may bill single-use vials of drugs and biologicals one time for one patient for one treatment. Anything more will land you in hot water, a Kentucky physician recently learned. Steven H. Stern, MD, and his practice, Kentuckiana Center for Better Bone and Joint Health PLLC (KCB), Louisville, Ky., recently agreed to pay $349,860 to settle allegations of overbilling Medicare for vials of the drug Infliximab (Remicade^®).

Amid all of the worry about looming Medicare cuts, here’s a kernel of good news: President Obama has repealed the 3% pre-payment tax withholding that would have applied to your Medicare payments. The repeal law, titled “3% Withholding Repeal and Job Creation Act” and signed Nov. 21, kills a little known change in the tax law that would have withheld 3% of your Medicare reimbursements and applied it to your federal taxes owed for that year.

You will be getting an extra year to prepare for the next level of meaningful use requirements, HHS officials say. Right now, you only have to meet stage 1 meaningful use rules, but in 2013 you would have to meet tougher stage 2 requirements. Stage 2 is being delayed to 2014, giving you an extra year to enjoy federal electronic health record (EHR) incentives while meeting only stage 1 requirements.

These charts look at Medicare denial rates for eight minor in-office procedures in 2009 and 2010, comparing denials for primary care practices and specialists. NOTE: “Primary care” is a combination of data from general practice, family practice, internal medicine and OB/GYN. NOTE: “Specialists” combines data from most other Medicare-recognized specialties, excluding those with low annual utilization such as plastic surgery.

Your non-physician practitioners (NPPs) will play leading roles in providing three newly covered services in 2012: screening and counseling for obesity, alcohol misuse and depression. These conditions are currently addressed as part of an office visit and you don’t get any separate reimbursement for them, experts say.

You can optimize your practice’s time by knowing when to it’s ok bill non-physician practitioner (NPP) services under your physician’s national provider number (NPI) outside of billing incident-to. While your NPPs can’t bill under the doctor’s NPI for major services such as E/M visits without meeting all of the incident-to requirements or billing under their own number, there are threekey scenarios in which you can that will optimize physician and staff time, experts say.