Download this month’s tool – a Covered Preventive Services Table – to help you, your front desk staff and billers keep track of the preventive services subject, and not subject, to patient fees.

While denial rates are a good way to look at codes that you need to improve your use of, some denials hurt a lot more than others. This chart shows ten high-utilization Medicare services that cost you a lot of money every time they are denied. 

2011 fee schedule impact by specialty

How does 99397 work with the pap and pelvic code G0101 and Q0091? I thought that the two pap codes would cover a well women exam with diagnosis code V72.31 and not need 99397. These are Medicare patients. Do I also need an advance beneficiary notice [ABN] signed for this and the Pap smear codes? Can I use the same diagnosis or does it have to pertain to something else?

Your non-physician practitioners (NPPs) will be impacted right along with your physicians starting April 1, 2011, when CMS begins to enforce its clinical signature requirement rule.

Take a second look at the requirements for billing medical nutrition therapy (MNT) services (97802-97804). Nearly one in every three medical nutrition therapy codes billed by you and your peers were denied in 2009 (PBN 1/17/11).

Patient presents to an NPP prior to a screening colonoscopy and it is discovered the patient has gastroesophageal reflux disease (GERD). The NPP bills an E/M visit with GERD as the primary diagnosis and then screening code (V76.51) second. The reason for the visit was not GERD but a screening colonoscopy. Do you have any reference material I can refer to for the reason for the visit not trying to find something to turn the screening visit into diagnostic?

Do non-physician practitioners (NPPs) order the same lab services as physicians? How frequently do they order them compared to physicians? The answers to these questions help give you an idea of how much your NPPs will be impacted by CMS’s clinical lab signature rule, set to be enforced starting April 1 (PBN 1/17/11)

You and your peers may see improper, automatic denials on claims for the new annual wellness visit (AWV) as a direct result of claims processing errors that affected “a few contractors,” a CMS official tells Part B News. “This is not a national problem,” she says. Following a tip from Part B News readers, agency officials took immediate action to investigate the problem and notify the Medicare Administrative Contractors (MACs) that were affected.