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06/17/2010

My doctor insists that we bill all of the services that used to be inpatient consults as initial hospital care codes. But I don't think some of the visits meet the requirements for those services and I'm concerned that will come up in an audit. He says that CMS knows that because consults are no longer covered there will be more initial inpatient billing. Is this allowed?

06/17/2010

Prices for electronic health record (EHRs) systems are based on many factors, starting with whether they use the client-server model or the application provider (ASP, see story) model. Here's how EHR fees typically break down for both client-server and ASP systems.

06/17/2010

Download the June Tool of the Month from the Part B News online Hot Documents library. The tool is a form letter to help you challenge underpayments when a discount has been wrongly applied to your reimbursement (see story). This letter is based on one developed by attorney Robin Fisk, of Ashland, N.H.

06/17/2010

This chart assigns a per-provider denial amount, in dollars, by assessing how often each specialty has denied claims and how many providers belong to the specialty.

06/17/2010

Medicare providers in North Carolina, South Carolina, Virginia and West Virginia won't have to worry about the chances of a disruptive Medicare Administrative Contractor (MAC) transition anytime soon. A protest has been filed against the award to Palmetto for the MAC contract to oversee those states in Jurisdiction 11 (PBN 6/7/10).

06/17/2010

In one month, a Medicare carrier denied a quarter million claims just because billers left off critical referring information to reimburse services. The offense: Your peers neglected to attach the referring provider's name and/or National Provider Identifier (NPI).

06/17/2010

You'll know you're not in CMS's Provider Enrollment, Chain and Ownership System (PECOS) when you receive a letter from your carrier this month. Two-page letters appearing on your carrier's letterhead are being mailed in standard-size envelopes to the practices and providers who aren't in PECOS.

06/17/2010

Be on the lookout for silent preferred provider organizations (PPOs) - private insurance companies that underpay you without your permission. You'll lose out on thousands of dollars - maybe without your knowledge - if you're not careful.

06/17/2010

You know you need to buy and implement an electronic health records (EHR) system soon to take advantage of federal incentives worth up to $44,000 per provider starting in 2011. The payout goes down the longer you wait (PBN 3/8/10). But what do you know about EHR systems right now - can you visualize what you'll get?

06/17/2010

You're looking at yet another temporary Medicare payment fix - this one with a 2.2% payment increase at least - after Senate negotiators failed to gain enough support for a longer term 19-month pay fix bill. The 2.2% increase, which still has not passed Congress as Part B News went to press, would be retroactive to June 1 but would expire Nov. 30.

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