You and your peers have found clinical quality measures (CQMs) to be one of the most confusing parts of meaningful use, with CQM questions dominating past open door calls held by CMS on its electronic health record (EHR) incentives. But reporting CQMs to get the first $18,000 incentive check isn’t hard, according to vendor experts and practices who already have the money in hand.

Don’t be surprised to deal with more private payers when treating Medicare beneficiaries, even when your patients are insured under traditional fee-for-service Medicare. Many managed care plans are expanding into the booming senior business by entering the lucrative Medicare supplement insurance market.

You must educate patients before and during annual wellness visits (AWVs) in order to boost their satisfaction and your chances of getting copays for E/Ms billed alongside AWVs, practice sources say. It’s common for enough separate physician work to occur in an AWV appointment that a significant, separate E/M service is billable, says Norma Keim, practice administrator at Cranberry Medical Clinic, a solo primary care practice in Terra Alta, W. Va. Remember: You attach modifier 25 (significant, separate E/M, same physician/day) to the E/M when billing it with the AWV.

Codes with modifier 59 (distinct procedural service) attached represent a major source of lost non-E/M revenue. This chart shows denial rates for high-utilization codes with modifier 59 attached in 2009 and compares them to their rates from 2005. NOTE: Codes with low utilization and/or low value (as measured by annual reimbursement paid out by Medicare) were excluded from analysis.

Hospital-affiliated physician practices could see drastically smaller reimbursements for non-diagnostic services rendered to patients who are subsequently admitted to the hospital, according to the 2012 proposed Physician Fee Schedule (PFS). Physicians in practices wholly owned or operated by a hospital be paid at the facility rate, instead of the non-facility rate at which they are currently paid, if their patient is admitted to the hospital within three days of visiting the physician for an issue related to the reason for admission.

Time is quickly running out for Congress to raise the $14.3 trillion debt limit by Aug. 2 and keep the U.S. from defaulting on its loans and threatening the billions of dollars in funding of government programs. But despite the tug-of-war taking place on Capitol Hill, there seems to be no details on if or how Medicare would be affected should the U.S. default, experts say.

What are the diagnosis codes that should be used to bill the Annual Wellness Visit (AWV)?