This chart looks at 10 lab codes that saw significant utilization growth from 2009 to 2010, and also had a high denial rate (classified as 10% or above). NOTE: Codes with low utilization or total reimbursement were excluded from analysis. Medicare claims data for clinical labs was eliminated, so this data reflects lab codes billed primarily by physicians and non-physician providers (NPPs).

We have a patient who comes in for allergy testing and then leaves the office with a vial of medicine for injection for the allergies. Medicare will only pay for one service per day. What modifiers and codes should be used?

Your non-physician practitioners (NPPs) are raking in more E/M income than any previous year, according to an exclusive NPP Report analysis of the latest Medicare claims data from 2010, the first year CMS stopped taking consultation codes (99241-99255). Remember: NPPs are permitted to bill consults so long as they are not billed incident-to, which would require a physician-initiated plan of care.

Your non-physician practitioners’ (NPPs) incident-to billing practices are a top target on the HHS’ Office of Inspector General (OIG) 2012 WorkPlan, which meansyour NPPs must be extremely careful when billing these services. NPPs are invisible on incident-to claims which is why it is so important to make sure a service musters up to the criteria, says Dianne Wilkinson, RHIT, a compliance auditor at West Tennessee Healthcare in Jackson, Tenn.

Who picks more high-level E/M codes, nurse practitioners (NPs) or physician assistants (PAs)? These charts examine the ratio of new and established patient E/M levels by NPs and Pas, comparing 2009 data to recently released 2010 data. NOTE: Incident-to services billed by non-physician practitioners (NPPs) appear as additional physician utilization in CMS claims data, thus the NPP services in this data do not include those that were billed incident-to.

According to Medicare guidelines for split-share billing, the non-physician practitioner (NPP) and physician must conduct distinct parts of the service. In which scenario is this most appropriate and how do you bill it?

You could be letting money walk right out the door if you don’t offer your patients enough ways to pay their bills. Practices now generate about a third of their revenue directly from the patient compared to 3% to 4% several years ago, says Rick Altinger, a vice president for Intuit Health. You always want to collect patient balances at the time of service, but offering patients multiple payment options boosts collection efforts.

You and your peers have steadily billed more observation services to Medicare and fewer inpatient care codes as requirements for inpatient status have tightened – but denial rates remain stubbornly high. With the creation of new subsequent observation codes in 2011 and CMS publishing different rules for their use than CPT, providers have more reasons than ever to be confused, experts say.

Your incident-to and E/M service billing will be subject to further scrutiny going forward as the HHS Office of Inspector General (OIG) will be looking for new errors in those areas and others as part of its just-released 2012 Work Plan (PBN 10/10/11). Several E/M services will continue to be targeted in the 2012 work plan, including the new addition of use of modifiers during the global surgery period.