You must take your documentation to the next level to avoid being snared by carriers who use tougher medical necessity standards on one of the most common service types: established E/M visits. Extremely high error rates – averaging 51% and 91% – were found for codes 99211-99215 by one carrier during its most recent medical review.
 

You and your peers must double down on documentation for prothrombin time or risk getting costly denials thanks to a marked growth in post-payment reviews that challenge prothrombin time billing. At least three Medicare Administrative Contractors (MACs) have posted Comprehensive Error Rate Testing (CERT) findings that show a clear focus on services with physician orders, including prothrombin time.
 

Expect payments for three ECG monitoring codes and a heart catheter insertion and placement code to change slightly due to fee schedule changes your Medicare Administrative Contractor (MAC) needs to implement by April 4, according to CMS transmittal 2167 to its Claims Processing Manual.

CMS and the Office of the National Coordinator for Health Information Technology (ONC) are hard at work on creating the official proposed rule for stage 2 meaningful use. What you can expect is found in the very first draft, the request for information (RFI) version of stage 2 measures.

CMS has changed the global days on simple repair codes (12001-12018) from 10 to 000 effective 1/1/11. Was it CMS’s intention to start allowing payment for post-op visits related to providing these procedures, such as providers now billing a low-level E/M involving suture removal?

You may be able to use registered nurses (RNs), licensed professional nurses (LPNs) or other licensed medical professionals unable to enroll in Medicare to perform the newly covered annual wellness visit (AWV) in its entirety under direct physician supervision and bill the service under the physician’s national provider identifier (NPI).

You will need to take the paper records for more than 50% of your patients and convert them to electronic records in your electronic health record (EHR) system, as well as ensure that 40% of your prescription are transmitted electronically in order to get your $18,000 bonus payment under the EHR Incentive Program.

Big changes are coming in 2012 to the way CMS pays Medicare Advantage (MA) plans, which in turn will impact the number of MA patients you see and how much you’ll be paid for seeing them. On average, MA plans will see a 1.6% reimbursement increase in 2012, but this figure will vary based on your region

Expect the reprocessing of claims impacted by passage of the Patient Protection and Affordable Care Act (PPACA) to begin in approximately two weeks, CMS officials announced during a recent conference call. But before you start a daily watch for these funds, note that the agency expects it to take months to re-run the hundreds of millions of claims impacted.