You have very few additions to and removals from CMS’s Average Sales Price (ASP) list to start the second quarter. In comparison to first quarter, drug prices remained stable and prices for the top drugs decreased by 0.4% on average. Prices changed 2% or less for 32 out of the top 50 higher volume drugs with 17 of the top 50 drugs seeing decreased.

You and your peers could improve patient care and earn extra money by being part of an accountable care organization (ACO), but this would be a major undertaking for smaller practices not made any easier by the proposed ACO, experts say. “We helped draft the proposed rule, so we certainly support ACOs,” says Chet Speed, vice president of public policy for the American Medical Group Association (AMGA). “But I think to make this thing attractive to a whole host of providers, there’s going to need to be some refinements.”
 

Recent national surveys show that practices with electronic health records (EHRs) remain in the minority, but the gap is shrinking rapidly, driven in part by CMS’s EHR Incentive Program. Those of your peers with EHRs do report high overall satisfaction levels, according to a major new study by the Medical Group Management Association (MGMA).
 

We are getting denials for services performed by our physicians in our recently opened ambulatory surgery center (ASC), but getting paid for the same service when done in our office. Are there site-specific ASC rules causing these denials? We bill the global service in each setting because the ASC is owned by our physicians.

You will not be required to enter every CPT code for advanced imaging that you bill by July 2011, but you are encouraged to start as soon as possible to get accredited and update your Medicare enrollment, CMS says. You have until Jan. 1, 2012 to get this done, but can begin the process in July 2011, a CMS official writes in an email to Part B News.

You and your peers are seeing a lot of patient interest in Medicare’s new annual wellness visit (AWV). To help shoulder the load, CMS policy allows you to use non-physician practitioners (NPPs) and, even lower-level licensed medical professionals unable to enroll in Medicare to perform AWVs.

You face relatively few changes from the latest round of Correct Coding Initiative (CCI) edits, version 17.1, which took effect April 1. Version 17.1 contains a total of 12,192 changes, less than half of the 29,600 changes from version 17.0 (PBN 12/16/10).

Your practice has a unique, long established way of getting things done. The thought of adding an electronic health records (EHR) system to the mix may seem daunting. But experts who talked to Part B News are confident that after the initial whirlwind of implementation, your practice will emerge to operate more efficiently.

This chart examines how primary care practices fare against specialists when billing the biggest, most common surgical procedures furnished in the office and outpatient hospital settings (place of service codes 11 and 22 respectively). Denial rates are clearly higher for primary care than for specialists, on a code-by-code basis. The percentages above the bars indicate the denial rate for each code in a given year; all denial rates are an average that reflects data from multiple specialties, e.g. “primary care” is an average of family practice, general practice, internal medicine, geriatrics and OB/GYN.