Make sure you don’t lose money from E/M visits that run longer than usual by documenting time spent and knowing when prolonged service codes come into play, experts say. Primary care physicians must deal with long visits when managing complex cases or severe diagnoses, while specialists have the challenge of using regular E/Ms in place of consult codes for Medicare referrals.

You risk disrupting your practice’s cash flow with stalled payments and claims denials if you fail to test claims in HIPAA version 5010 before the nationwide switch on Jan. 1, 2012. With less than four months until the deadline, experts are urging providers to test now amidst growing concerns that practices don’t see 5010 as a major potential threat to revenue.

When your physicians get a low quality rating by a private insurance plan, the result could be a drop in new patients, lower rates in your next contract negotiation or even being forced to charge different copays for different doctors within your practice. You must know how to appeal a low quality rating for existing plans and ask about the ratings system when negotiating with new plans, experts say.

Your primary care physicians can shift their Medicaid caseload and use patients on private Medicaid plans to qualify for a $21,250 incentive check under the Medicaid Electronic Health Record (EHR) Incentive Program, CMS officials say. The Medicare bonus is worth less at $18,000 and requires you to meet meaningful use; one of the biggest benefits of the Medicaid bonus is that meaningful use does not have to be met during the first year of participation in the program.

Is there a difference between E/M level selection on the Medicare and private payer sides? For the first time, we analyze E/M level ratios between Medicare and private payers based on claims data from more than thousands of practices nationwide. These charts are based on data compiled via the analytics tool of RelayHealth, an Atlanta-based health information technology firm, representing data from thousands of physicians nationwide.

I recently noticed that G0102 is bundled with G0438 in CCI edits. I am confused by this, because I did not understand G0438 to be a physical examination, but rather a wellness visit. In reviewing the requirements of a G0438, there is nothing that would indicate an examination. Do you know why they are now bundled?

Download this month's tool -- a spreadsheet showing time thresholds for base E/M codes and prolonged service codes -- to help you capture extra revenue from time-consuming, counseling-dominated encounters. You can use the time thresholds to determine whether you can bill a prolonged service code (99354-99359) or whether a standalone base E/M code must be billed, based on typical time as defined by CPT.

You can’t afford to sit on claims that were denied due to common mistakes such as forgotten modifiers and wrong diagnosis codes. The best practices are aggressive, turning these around the same day by fixing them over the phone or by quickly firing off a redetermination request. "Fix it right away or appeal right away, so you don’t have a situation where you could be making the same mistake on future claims,” urges Maxine Lewis, CPC, president of Medical Coding & Reimbursement Management in Cincinnati.