You must have patients complete more paperwork when billing annual wellness visits (AWVs) next year, thanks to the 2012 Physician Fee Schedule (PFS) final rule. CMS has gone ahead and finalized the requirement that patients complete a health risk assessment (HRA) as part of the AWV service.

The HRA is a form your practice will develop (CMS provides no ready-made template) for patients to complete either before or during an AWV. It’s intended to be a plain-English form that takes 20 minutes or less to complete, and asks patients a wide variety of questions to help determine their risk factors. CMS wants your providers to incorporate HRAs in their AWV, and specifically, in giving patients the personalized prevention plan that’s already a requirement of the AWV.

You will see very little changes in 2011’s last round of coding revisions in the most recent Correct Coding Initiative (CCI) edits, version 17.3, which took effect Oct. 1. There are a total of 2,271 changes, just under the 2,703 changes from version 17.2 (PBN 7/4/11), an exclusive Part B News analysis shows.

NOTE: The CCI manual will not be released until Dec. 1 and will take effect Jan. 1, 2012 rather than the usual Oct. 1 release/effective date, CMS says on its website. Part B News will report any major changes to the CCI manual upon its release.

View the estimated impact of CMS's Final 2012 Physician Fee Schedule by specialty.

This chart looks at denial rates and utilization changes for 10 major surgical procedures that are some of the highest-value services paid by Medicare, based on the latest CMS claims data. NOTE: While a denial rate of 10% or more is typically considered high, each of these codes are worth thousands of dollars, so a rate of 5% or more is considered high, given the amount of revenue at stake.

Is it correct to bill a claim with modifier 25 if a patient comes in to get allergy testing but also wants to see the doctor for an office visit in the same day? In this case, our practice usually bills with modifier 25 but Medicare only pays for the lesser charge and denies the other. How can we get paid for both?

This sample letter will serve as a great tool for your practice when going to renegotiate your reimbursement rates with your private payer.  You can use the letter, in PDF format,  as a guide when writing your own renegotiation letter, says the letter's author Brian Agnew, president of Supero Healthcare Solutions in Austin, Texas.

The key: Your letter should be straightforward and brief, no more than two pages, dictating what you want to renegotiate and a glimpse of why your practice is important to the payer and the leverage it can offer, experts say (PBN 10/31/11). The key is to explicitly say what you want to do without tipping your hand, Agnew says.

It’s up to you to start negotiation talks with your payer and get a rate increase. But to get the ball rolling in your favor, you must approach your payer in the right way and be persistent. For example, start by trying to schedule a casual chat with them to issue a head’s up that you want to renegotiate your contract, experts say.