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08/15/2011

This table gives a snapshot of three different "free" electronic health records (EHR) system vendors, breaking down the EHR's features, noting any associated fees and a quick profile of the EHR's user base (PBN 8/15/11). 

08/15/2011

You must be ready to use the right modifier when billing many common services in the same encounter as the new annual wellness visit (AWV), according to an exclusive Part B News analysis of the latest version of the National Correct Coding Initiative (CCI) edits. The initial AWV code, G0438 (initial wellness visit, $161.05), is now subject to more than 100 edits in CCI version 17.2, which went into effect July 1.

08/15/2011

Twice as many E/M codes are billed in the outpatient setting than inpatient, but the average denial rate is higher in the outpatient setting. This chart compares the E/M codes on a level-by-level basis in the two settings to examine where the denials are happening. NOTE: The “outpatient” setting is a combination of CMS claims data for place of service (POS) codes 11 (office) and 22 (outpatient hospital), while the “inpatient” setting is a combination of POS codes 21 (inpatient hospital) and 23 (emergency room).

08/15/2011

CMS took questions from your peers on the new advanced diagnostic imaging requirement, the Primary Care Incentive Payment (PCIP) program and the agency’s ongoing efforts to reprocess claims, but the answers don’t offer fast solutions. Here’s the rundown on the top issues CMS addressed during its latest Aug. 9 open door call for physicians and non-physician practitioners.

08/15/2011

Can primary care physicians (MDs) be paid by Medicare for CPT codes for health and behaviorial assessment services (96150-96152)? If not, are there any HCPCS codes they could use?

08/08/2011

You have 13 months to purchase, implement and optimize an electronic health record (EHR) system, reach meaningful use and report it to CMS. The cut-off date to begin meaningful use attestation and earn the first $18,000 incentive payment is Oct. 1, 2012. That’s a date that most of your peers don’t plan to miss, a Part B News reader survey found (see survey results here).

08/08/2011

CMS could potentially owe you, or you may have to pay back, thousands of dollars via claims reprocessing of underpaid and overpaid 2010 fee-for-service (FFS) claims, due to the retroactive effective dates of health reform provisions and corrections to the Physician Fee Schedule. But the only way to get that free money is to go through your explanation of benefits (EOB) sheets line by line.

08/08/2011

The financial and emotional cost of dealing with a billing audit, HIPAA investigation or other compliance problem can be daunting. That’s why many of your colleagues are turning to audit insurance to help them out in the event they end up in a regulator’s crosshairs. Audit insurance, sometimes called investigation, regulatory, cyber liability or “medefense” insurance, won’t cover actual overpayments or admissions of fraudulent billing.

08/08/2011

Audit insurance varies widely (see main story here). Here are eight questions to consider before you shell out your money for a policy.

08/08/2011

You face four small but potentially revenue-freezing obstacles with Medicare enrollment, Part B News has learned. Two appear to be typos in the latest CMS-855B enrollment form, dated July 11, and two affect only the agency’s web-based Provider Enrollment Chain Ownership System (PECOS). Here’s a rundown on the four possible problems

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