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04/25/2011

You might receive an unexpected bonus payment from Medicare thanks to the Primary Care Incentive Payment (PCIP) program, Part B News has learned. It would be unexpected because your providers didn’t actually furnish any primary care. At least one practice in Pennsylvania got a surprise electronic payment worth $2,700 from Highmark, the Medicare Administrative Contractor (MAC). But this practice consisted only of pain management specialists and four physician assistants.

04/25/2011

You have just five months to choose an electronic health record (EHR) system, negotiate a contract and make preparations for implementation – any delays will drastically decrease your chances of collecting the first $18,000 bonus check, paid per provider, under the EHR Incentive Program, experts say. To be ready to demonstrate meaningful use on Oct. 1, 2012 – just 17 months from now – you must be ready to have an EHR system installed by October of this year, according to an expert’s roadmap.

04/25/2011

Many of your peers don’t believe their practice management software and electronic health records (EHRs) are currently compatible with the new HIPAA 5010 transaction standard, which could leave many fumbling to meet the Jan. 1, 2012 deadline, experts say. Nearly 25% of practices report not knowing what needed to be done with their software to comply with HIPAA 5010, according to a Medical Group Management Association (MGMA) survey.

04/25/2011

You must actively seek reprocessing of claims submitted to Medicare for a variety of radiology and diagnostic ultrasound services via skilled nursing facility (SNF) consolidated billing. Almost all 2011 claims for a total of 37 codes in the 76000 range could potentially be impacted, CMS said in a March 21 posting. The majority of these codes are diagnostic ultrasounds, which were billed to Medicare for the professional component (PC) of each service with modifier 26 (professional component) appended.

04/25/2011

You have until June 30 to e-prescribe to 10 unique patients or else you’ll be hit by a 1% penalty to all Medicare payments in 2012 – and you won’t catch a break if you were planning to meet this requirement via an electronic health record (EHR) system later this year. Unless you already have a way to e-prescribe, you’ll have to buy a standalone system and meet the 10-patient threshold to avoid the penalty, experts say.

04/25/2011

This chart analyzes how primary care practices have branched out in terms of billing services typically billed by specialists over the last five years for which CMS claims data is available. Services are considered “specialist” when a non-primary care specialty or specialties are responsible for the majority of annual Medicare utilization. Denial rates are not shown, but the data is overwhelming that while primary care may be billing more of these specialist services than before, they don’t do so nearly as well as specialists.

04/25/2011

Download this month’s tool – an Electronic Health Record Preparedness Assessment created by the California HealthCare Foundation – to help you estimate how much work awaits you in the EHR implementation process. This tool is widely used by technology consultants to gauge the readiness of a wide variety of practices to adopt an EHR system.

04/25/2011

We used code G8443 to report that we are e-prescribing, but we’ve been told this code was deleted. Could you please supply us with the new reporting codes?

04/25/2011

Your physicians can bill Medicare for annual wellness visits (AWVs) that were performed by one or more non-physicians, such as nurse practitioners and registered nurses, so long as they provided direct supervision. Confusion arose over whether AWVs can be billed in this way, which gives you the full Medicare fee schedule payment; a nurse practitioner or other non-physician practitioner (NPP) billing under their own identifier would be paid at 85% of the fee schedule rate.

04/25/2011

The health reform law has given you and your peers more billing opportunities that will boost your revenue but likely crowd your schedule. Non-physician practitioners (NPPs) can render these services along with the annual wellness visit, leaving physicians to concentrate on higher-value, more complex services, experts tell NPP Report.

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