An overwhelming majority of your peers will implement electronic health records (EHRs) and attempt to meet meaningful use, with many already using EHR systems, according to an unscientific Part B News survey of 126 practices nationwide. NOTE: The survey is likely biased in favor of EHR because practices with EHRs or that are interested in them are more likely to participate.

Codes with modifier 55 (post-op management only) attached have the highest denial rates of codes with modifiers, beating out modifiers unbundling E/M codes (25 for separate, significant E/M). This chart shows denial rates for high-utilization codes with modifier 55 attached in 2009 and compares them to their denials in 2005. 

While CMS has stated you can bill an office visit on the same day as the Annual Wellness Visit (AWV), in a recent CMS provider forum, they made it very clear that there could be no “double dipping” of the documented elements from the AWV to meet a given level of E/M. How does the prohibition on “double dipping” affect the documentation requirements for the patient’s history of the present illness, medications, past surgical history, family history  and review of systems?  What do you see as the “maximum” level of new patient E/M that could be used if the physician/practitioner fulfills the requirements of the AWV?

NOTE: This story has been updated and was published in the August 15, 2011 issue of Part B News. You can read the updated story here: LINK.

You must revalidate the complete enrollment information of all providers who enrolled with Medicare before March 25, 2011. You must get this done by March 23, 2013, or face the same consequences of any late revalidation: frozen Medicare payments. CMS made it official in MLN Matters article, number SE1126, released Aug. 5. Expect to receive a revalidation notice from your Medicare contractor asking you to revalidate, CMS says. Contractors will send out notices "on a regular basis," the agency writes.

When patients don’t show up, you lose money and waste physician time – the kind of damage you can’t afford in this economy. Many practices are adopting no-show fees, but to really reduce no-shows, you must do a lot more than post a warning sign, experts say. It’s more important than ever to tackle no-shows, which have become more common, particularly for well visits and conditions that patients feel aren’t very serious, says Mark Rosenberg, CPA, president of Rosenberg and Company in Atlanta.

You and your peers have found clinical quality measures (CQMs) to be one of the most confusing parts of meaningful use, with CQM questions dominating past open door calls held by CMS on its electronic health record (EHR) incentives. But reporting CQMs to get the first $18,000 incentive check isn’t hard, according to vendor experts and practices who already have the money in hand.

Don’t be surprised to deal with more private payers when treating Medicare beneficiaries, even when your patients are insured under traditional fee-for-service Medicare. Many managed care plans are expanding into the booming senior business by entering the lucrative Medicare supplement insurance market.

You must educate patients before and during annual wellness visits (AWVs) in order to boost their satisfaction and your chances of getting copays for E/Ms billed alongside AWVs, practice sources say. It’s common for enough separate physician work to occur in an AWV appointment that a significant, separate E/M service is billable, says Norma Keim, practice administrator at Cranberry Medical Clinic, a solo primary care practice in Terra Alta, W. Va. Remember: You attach modifier 25 (significant, separate E/M, same physician/day) to the E/M when billing it with the AWV.

Codes with modifier 59 (distinct procedural service) attached represent a major source of lost non-E/M revenue. This chart shows denial rates for high-utilization codes with modifier 59 attached in 2009 and compares them to their rates from 2005. NOTE: Codes with low utilization and/or low value (as measured by annual reimbursement paid out by Medicare) were excluded from analysis.