You will have many more reasons to switch from paper enrollment forms to CMS’s web-based Provider Enrollment Chain Ownership System (PECOS) in 2012, Part B News has learned. Currently, online PECOS lets you enter most enrollment updates or new enrollment information electronically, but you must still sign and mail paper forms as part of the process.

 Does greater volume of utilization impact denial rates for imaging services, or does the actual value of the Medicare payment have a greater effect? These charts sort 10 imaging services by their 2011 fee schedule charge, from lowest to highest value, and show the denial and utilization rates in 2007 and 2009.

I would like clarification on certification rules for Medicare coverage clarified by CMS. For the third hospice benefit period, a face-to-face visit must be documented in the certification form. It states that a hospice physician or nurse must do the certification. At the end of the article you then state “remember, the certification may also be done by the hospice medical director when the patient does not have an attending physician.” Does that mean the attending physician may do the initial, subsequent and third certification for hospice benefit? I was under the impression that the attending could do certifications. 

You must revalidate every provider who was enrolled in Medicare before March 25, 2011, but you must wait for a letter asking you to start from your Medicare Administrative Contractor (MAC). Your deadline for this is March 23, 2013, after which payments will be frozen until providers are revalidated in the Provider Enrollment Chain Ownership System (PECOS), whether via the online PECOS website or on paper.

Your peers have long cited the upfront cost of an electronic health record (EHR) system as a top obstacle to adoption, but some vendors are offering EHRs for free, based on unique business models. Free EHRs represent just a fraction of the overall market, but they seem to be growing and many have been certified by CMS-approved agencies to meet meaningful use requirements and thus deliver up to $44,000 in EHR incentive cash under Medicare (click here for a quick profile of three free EHR vendors).

Many practices have seen revenues fall as a result of private payer patients not meeting their copay and deductible obligations. But perfecting your practice’s collection techniques is the only way to plug the revenue leak, experts tell Part B News. An increase in premiums, plus employers adjusting their health plans to include higher deductibles have shifted greater financial responsibility to patients, experts say.

Your claims with modifiers 58 (staged, related service, post op, same physician) or 78 (return to or for related procedure, post op, same physician) attached have a higher rate of being denied, according to a Part B News analysis of CMS claims data. Experts say the onus is on you to ensure proper usage of modifiers.