Most practices continue to accept all new Medicare patients, and specialists accept them at higher rates than primary care doctors despite continued stagnation in payments and the threat of pay cuts, according to cumulative surveys of physicians by the Center for Studying Health System Change (HSC). The bold percentages above the bars show the average acceptance rate for each amount of new patients. Specialists are more likely to accept new patients as they are often referred on a case-specific basis and don't stay in the practice, as a patient does with a primary practitioner.

Question: I'm trying to pin down Medicare's rules for 45378 (Diagnostic colonoscopy, $368.96) vs. G0121 (low risk screening colonoscopy, $368.96). A physician listed rectal bleeding as the primary diagnosis, but he states the procedure performed was a "screening colonoscopy." If coverage limitations are met and there aren't any other findings, how should we report it? It's my understanding that a screening is only indicated when the patient presents without any symptoms.

Update your practice's security plan for health information security breaches today. Your practice will need to take extra steps to prevent and mitigate breaches under a new law set to take effect next year. The American Recovery and Reinvestment Act (ARRA), known as the 2009 stimulus bill, provides you with a better definition for what constitutes a breach of patient health information. At the same time, the act increases penalties for when a breach occurs in your office.

Here are the official CMS definitions and codes for three places of service mentioned in a recent HHS Office of Inspector General (OIG) report. Keep this information handy to clear up any confusion over where a service was provided.

Licenses and a facility cost report will show which buildings and offices are owned and operated by a hospital, ambulatory surgery center (ASC), or outpatient facility. Checking these sources will help you determine the correct place of service when your billing department is ever unsure where a service actually took place. The HHS Office of Inspector General (OIG) found several cases where the location of a physician's office was incorrectly reported on claims, and now estimates physician practices have been overpaid $20 million over two years, according to a recent report. Expect the government to want that money back. 

Lawmakers in both houses of Congress are moving forward again on crafting a comprehensive health reform bill, but all versions of the legislation include either long-term cuts to Medicare payments or cost-containment measures, Part B News has learned. It's not clear how future cuts would interact with the scheduled 21.5% pay cut for 2010, because the new draft legislation hasn't been released yet.

Your current carrier or Medicare Administrative Contractor (MAC) is almost guaranteed to intensify its own auditing process using the same targets chosen by your recovery audit contractor (RAC) when the permanent program begins, CMS and experts say.

This week's question was answered with the assistance of Margie Scalley Vaught, CPC, Coding Content Specialist for DecisionHealth.  

Q. Can you bill codes 95165 (Antigen therapy prep, $11.54) through 95170 (Antigen therapy prep, $9.02) ‘incident to' if a physician assistant or nurse practitioner prepares the vials of antigens?

High-dollar and high-volume services are guaranteed to top the list of targets recovery audit contractors (RACs) will look for, experts say. That makes physical therapy (PT) a particularly obvious target for RACs once the permanent program goes live sometime this summer.

This chart shows how Medicare payments for ten codes commonly billed by non-physician practitioners (NPPs) will change if the proposed 2010 Physician Fee Schedule is implemented.