Part B News | Part B News

Tool of the Month: Pre-authorization and Patient Coverage Verification Form

07/25/2011

Download this month’s tool – a Pre-authorization and Patient Coverage Verification Form– to help you prevent claims denials for pre-certified services by collecting as much of the patient's carrier information upfront and avoiding complications down the line.

The form is available exclusively to Part B News subscribers for free. Subscribers have permission to download the form and use it at their practice or office. Download this file by clicking the “Download File” link found at the top of this article at www.partbnews.com.

5 proven tips to bill wellness visits without slowing your doctors down

07/25/2011

by: Grant Huang

Your peers find it hard to make annual wellness visits (AWVs) worth the extra physician time and effort, but some practices have found ways to make AWVs a significant money-maker by streamlining appointments, educating patients and leaning heavily on ancillary staff, such as non-physician practitioners (NPPs) and medical assistants (MAs).

5 steps to protect patient data, meet meaningful use security requirement

07/25/2011

by: Grant Huang

You must always protect patient data under HIPAA, but you must go a step further to meet meaningful use and collect your first electronic health record (EHR) incentive payment of $18,000. While you are already required to follow security standards for electronic health information, the final mandatory or “core” meaningful use measure 15 asks for much more. Here are five ways to meet it.

E/M codes win, imaging loses under continuing transition to new dataset

07/25/2011

by: Lauren C. Williams

You would enjoy slow but steady payment increases to E/M services under the proposed 2012 Medicare Physician Fee Schedule (PFS) while imaging services take a pay hit. This is a gradual trend that can be directly linked to CMS’s transition from a dataset long used to calculate relative value units (RVUs) to a new one, experts tell Part B News.

CMS has new way to target claims

07/25/2011

by: Lauren C. Williams

Fraudulent claims will no longer be paid first and investigated later come July 1 when CMS launches its new predictive modeling initiative. CMS’s new tactic against fraud, a product of health reform, will be similar to technology used by credit card companies. Claims will be analyzed using risk scoring technology that will identify suspicious Medicare claims before they are paid.

How to fend off payer repayment demands and inappropriate offsets

07/25/2011

by: Marla Durben Hirsch

Private payers are becoming more aggressive in their demands that your practice return money in cases of mistaken overpayment. Even worse, payers just won a major victory backing their right to unilaterally seize these overpayments by offsetting them from money they owe you but haven’t yet paid.

Benchmark of the Week: E/M usage by specialty and visit type, 2009

07/25/2011

by: Grant Huang

Are you billing more higher-level E/Ms than the average for your specialty? What about lower-level E/Ms or new patient vs. established E/Ms? These charts give you a baseline to compare against in the form of four top E/M-billing specialties: dermatology, family practice, orthopedic surgery and podiatry.

Ask a Part B News Expert: Medical necessity and E/M documentation

07/25/2011

If all the documentation requirements are met for a certain level of service, but the medical necessity of the visit is less than that required for a particular level, bill the lower level? Who is determining the medical necessity of each level and how is it determined?

NPPs to suffer same losses as physicians due to changing RVUs

07/25/2011

by: Lauren C. Williams

Non-physician practitioners (NPPs) in imaging and radiology will see the same pay cuts as their specialty providers despite CMS’s projections that nurse practitioners (NPs) and physician assistants (PAs), in general, would see a pay gain during the dataset transition for calculating reimbursement rates, experts say.

NPP Report: 3 tips to use NPPs to bill smoking cessation services

07/25/2011

by: Grant Huang

Your non-physician practitioners (NPPs) have been billing more and more smoking cessation services, though denials remain surprisingly high. Cutting denials and focusing on this fast-growing service could be even more important in 2012,because smoking cessation would become billable as a telehealth service under the 2012 Medicare Physician Fee Schedule (PFS) proposed rule, an NPP Report analysis shows.

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