You have just over two months left to upgrade to and successfully send test claims through HIPAA version 5010 software. Testing a claim in 5010 with your clearinghouse or payer can take days or weeks before you get a response and there are a lot of new requirements that could trip providers up and cause their test claims and potentially live claims to be denied, experts say (PBN 9/12/11).

Expect either a letter or an email from your Medicare Administrative Contractor (MAC) warning you that you face a 1% payment penalty in 2012 under the e-prescribing (e-Rx) rule. CMS will send a separate letter or email to practices that submitted an e-Rx hardship exemption to avoid the penalty, that informs them whether their request was approved or denied.

These charts compare how primary care providers perform against specialists when it comes to denial rates on common surgery services. For each of these codes, primary care is responsible for a significant share of utilization, despite the fact that specialists still bill the majority to Medicare. NOTE: “Primary care” reflects combined data from family practice, general practice, internal medicine, geriatrics and OB/GYN. The “specialists” category represents combined data for more than 20 other specialties, excluding only those with low Medicare utilization (e.g., plastic surgeons). NOTE: The percentages above the bars reflect averagedenial rates.

At what point after an initial event is a condition considered “a manifestation of a late effect of the condition,” such as a stroke? Is it six months?

You must contact CMS if you want to know whether your hardship exemption to avoid the 1% e-Prescribing (e-Rx) payment penalty was granted, Part B News has learned. After you submit the exemption, CMS won’t give you a response either way; unless it needs additional documentation to make a decision, a CMS official tells Part B News.

Many practices have been switching banks as the economic slump drags on and some banks impose new and higher fees, combined with tighter standards for loans and lines of credit. But to switch to a new bank without disrupting cash flow, you must plan for a four to six-month process that involves having two accounts open and juggling payer paperwork, experts say.

You must be ready with advanced beneficiary notice of non-coverage (ABN) forms when facing services that Medicare will only cover with the right diagnosis code, and statutorily reject in all other situations. Here are five expert tips on how to recognize and prevent potentially non-covered services and avoid ABN overuse.

You and your peers earned more E/M revenue in 2010 than 2009, even though 2010 was the first year consult codes were eliminated. These charts show E/M revenue and utilization based on CMS claims data. For the top 10 E/M-billing specialties, 2010 was a year that saw positive E/M growth, with the exception of general surgery and ophthalmology.

These charts examine E/M code level selection for new and established visits (99201-99215) from 2009 to 2010, comparing primary care and specialists. Both primary care and the top E/M-billing specialists show a clear shift from lower-level E/Ms to higher level E/Ms. However, the shift for specialists is much sharper, driven by CMS eliminating consult code codes in 2010, which is a huge E/M change.