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Hospital practices could lose revenue with proposed 3-day requirement

08/01/2011

Hospital-affiliated physician practices could see drastically smaller reimbursements for non-diagnostic services rendered to patients who are subsequently admitted to the hospital, according to the 2012 proposed Physician Fee Schedule (PFS). Physicians in practices wholly owned or operated by a hospital be paid at the facility rate, instead of the non-facility rate at which they are currently paid, if their patient is admitted to the hospital within three days of visiting the physician for an issue related to the reason for admission.

Debt ceiling’s impact on your Medicare payments is unclear

08/01/2011

by: Lauren C. Williams

Time is quickly running out for Congress to raise the $14.3 trillion debt limit by Aug. 2 and keep the U.S. from defaulting on its loans and threatening the billions of dollars in funding of government programs. But despite the tug-of-war taking place on Capitol Hill, there seems to be no details on if or how Medicare would be affected should the U.S. default, experts say.

Ask a Part B News Expert: AWV diagnostic codes

08/01/2011

What are the diagnosis codes that should be used to bill the Annual Wellness Visit (AWV)?

Tool of the Month: Pre-authorization and Patient Coverage Verification Form

07/25/2011

by: Lauren C. Williams

Download this month’s tool – a Pre-authorization and Patient Coverage Verification Form– to help you prevent claims denials for pre-certified services by collecting as much of the patient's carrier information upfront and avoiding complications down the line.

The form is available exclusively to Part B News subscribers for free. Subscribers have permission to download the form and use it at their practice or office. Download this file by clicking the “Download File” link found at the top of this article at www.partbnews.com.

5 proven tips to bill wellness visits without slowing your doctors down

07/25/2011

by: Grant Huang

Your peers find it hard to make annual wellness visits (AWVs) worth the extra physician time and effort, but some practices have found ways to make AWVs a significant money-maker by streamlining appointments, educating patients and leaning heavily on ancillary staff, such as non-physician practitioners (NPPs) and medical assistants (MAs).

5 steps to protect patient data, meet meaningful use security requirement

07/25/2011

by: Grant Huang

You must always protect patient data under HIPAA, but you must go a step further to meet meaningful use and collect your first electronic health record (EHR) incentive payment of $18,000. While you are already required to follow security standards for electronic health information, the final mandatory or “core” meaningful use measure 15 asks for much more. Here are five ways to meet it.

E/M codes win, imaging loses under continuing transition to new dataset

07/25/2011

by: Lauren C. Williams

You would enjoy slow but steady payment increases to E/M services under the proposed 2012 Medicare Physician Fee Schedule (PFS) while imaging services take a pay hit. This is a gradual trend that can be directly linked to CMS’s transition from a dataset long used to calculate relative value units (RVUs) to a new one, experts tell Part B News.

CMS has new way to target claims

07/25/2011

by: Lauren C. Williams

Fraudulent claims will no longer be paid first and investigated later come July 1 when CMS launches its new predictive modeling initiative. CMS’s new tactic against fraud, a product of health reform, will be similar to technology used by credit card companies. Claims will be analyzed using risk scoring technology that will identify suspicious Medicare claims before they are paid.

How to fend off payer repayment demands and inappropriate offsets

07/25/2011

by: Marla Durben Hirsch

Private payers are becoming more aggressive in their demands that your practice return money in cases of mistaken overpayment. Even worse, payers just won a major victory backing their right to unilaterally seize these overpayments by offsetting them from money they owe you but haven’t yet paid.

Benchmark of the Week: E/M usage by specialty and visit type, 2009

07/25/2011

by: Grant Huang

Are you billing more higher-level E/Ms than the average for your specialty? What about lower-level E/Ms or new patient vs. established E/Ms? These charts give you a baseline to compare against in the form of four top E/M-billing specialties: dermatology, family practice, orthopedic surgery and podiatry.

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