Survey data shows the key to a successful appeals strategy is to focus your efforts on the denials you know you can win and avoid wasting time when the payer's decision is most likely correct (see survey results and analysis). Your challenge is to quickly spot winnable denials.

We're having difficulty determining when it is appropriate to bill for a skin biopsy. Some of our clinicians believe they can bill a biopsy only when they use specific methods for removing the suspect lesion. I don't believe this is correct. Could you point me to some documentation that provides guidance?

Denial rates for most specialties don't seem to differ significantly whether their services are done in the office or outpatient hospital setting. This chart shows how specialty-specific denial rates compare to the average or baseline denial rate for the office and outpatient hospital settings. The five specialties with the greatest positive and negative deviations from the baseline denial rate in a given place of service (POS) were chosen.

The Medicare Administrative Carrier (MAC) Highmark processed Medicare claims with a conversion factor using the 21% sustainable growth rate (SGR) cut - costing you and your peers time and money. Double check to make sure your own carrier didn't process claims at the lower rate just to be sure. Initially, Highmark announced the MAC held claims and none were processed at the reduced rate.

Federal officials slightly loosened electronic prescribing requirements you must follow to prescribe narcotics in a final rule effective June 1. In short, you'll need to take four steps to set yourself up to e-prescribe narcotics at your practice, say experts who spoke with Part B News about the new Drug Enforcement Agency (DEA) rule.

Increased efficiency and a new, effective way to communicate with patients were two benefits one OB/GYN in Texas saw when he adopted a patient portal at his practice - economic and practical benefits you can see as well. The physician can't quantify how much he saved or how much extra money his practice has earned, but his practice has continued to grow because of the patient portal and the benefits justify the costs.

You and your peers have been using advance beneficiary notice of non-coverage (ABN) forms less frequently over the last few years, according to a Part B News analysis of the latest available CMS claims data from 2008. The number of all Medicare Part B claims billed with the GA modifier (waiver of liability statement issued, as required by payer policy) fell to a five-year low of about 37.5 million in 2008.

This week's question is answered by Sean Weiss, CPC, vice president, DecisionHealth Professional Services. 

Q. Can non-physician practitioners (NPPs) such as physician assistants (PAs) or nurse practitioners (NPs) have reciprocal billing arrangements with one another if all of the PAs/NPs are enrolled in Medicare?

Summary: Non-physician practitioners (NPPs) are billing more simple dermatology services while utilization among dermatologists and primary care providers is decreasing, according to an NPP Report analysis of CMS claims data from 2006 to 2008, the latest available.

Non-physician practitioners (NPPs) are billing more simple dermatology services such as skin tag removal and basic lesion excision, a sign that physicians want to concentrate on tougher, higher-value dermatology services while using NPPs to fill a growing demand for simple dermatology procedures, experts say. While NPPs generally bill simple dermatology services without a hitch, denial rates have climbed.