Proposed rules for stage 2 meaningful use of electronic health records (EHR) mean added HIPAA obligations and risks to incentive payments if your practice doesn’t comply. The stage 2 proposed rules do not “override” or “change” the HIPAA privacy and security rules, CMS states.

You will get paid less for your most frequently billed drug codes thanks to price slashes in CMS’ latest average sales price (ASP) list effective April 1. Of the 60% of top-billed codes that saw price changes, nearly a quarter were decreases, a Part B News analysis of 2010 CMS claims data and ASP data shows.

Don’t leave money on the table by opting not to schedule annual wellness visits (AWVs) or performing them inefficiently. CMS clarifications on the 2011-initiated preventive service offer a prime opportunity to sharpen your process. For example, the regulations allow for you to perform AWVs once the patient is already at your office – as many of your peers have elected to do.

Verify private pay patients’ benefits before you provide preventive services to avoid losing money because of the lack of coverage in grandfathered plans. Under the Affordable Care Act (ACA), Medicare and most private insurance plans now must cover a growing number of preventive services, often without a copay. But there’s a hidden risk when rendering those services. 

Practices that followed WPS carrier instructions to document extended history of present illness (HPI) with three or more chronic conditions when using the 95 E/M guidelines must retrain staff to follow the “four or more elements” requirement to avoid lost payments. If physicians choose to use the 97 guidelines, they can document the status of three chronic conditions but must record whether those conditions are improving, stable or declining.

Practices will have more time to prepare for Medicare’s new place-of-service (POS) policy. Days before the policy’s original April 1 effective date, CMS announced it would put off implementation until Oct. 1 this year to “allow CMS to address questions received and to make any necessary changes,” according to a March 29 CMS transmittal.

This chart shows the 2010 denial rates of three frequently billed codes for seven Medicare-heavy specialties and compares those rates with the 2009 percentages. All numbers are based on a Part B News analysis of 2010 and 2009 Medicare claims data. Note: The 2010 codes selected had at least a 10% denial rate and a total service count per specialty of at least 10,000. Medicare paid at least $5 million per specialty in 2010 for each of these codes. 

Can you bill an E/M visit with modifier 25 (separate, significant E/M) if you are also billing G0446 (intensive behavioral therapy for heart disease risk)? (Here’s the link the subscriber provided to Palmetto’s policy: http://tinyurl.com/cdck6sv.)