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08/08/2011

You have 13 months to purchase, implement and optimize an electronic health record (EHR) system, reach meaningful use and report it to CMS. The cut-off date to begin meaningful use attestation and earn the first $18,000 incentive payment is Oct. 1, 2012. That’s a date that most of your peers don’t plan to miss, a Part B News reader survey found (see survey results here).

08/08/2011

CMS could potentially owe you, or you may have to pay back, thousands of dollars via claims reprocessing of underpaid and overpaid 2010 fee-for-service (FFS) claims, due to the retroactive effective dates of health reform provisions and corrections to the Physician Fee Schedule. But the only way to get that free money is to go through your explanation of benefits (EOB) sheets line by line.

08/08/2011

The financial and emotional cost of dealing with a billing audit, HIPAA investigation or other compliance problem can be daunting. That’s why many of your colleagues are turning to audit insurance to help them out in the event they end up in a regulator’s crosshairs. Audit insurance, sometimes called investigation, regulatory, cyber liability or “medefense” insurance, won’t cover actual overpayments or admissions of fraudulent billing.

08/08/2011

Audit insurance varies widely (see main story here). Here are eight questions to consider before you shell out your money for a policy.

08/08/2011

You face four small but potentially revenue-freezing obstacles with Medicare enrollment, Part B News has learned. Two appear to be typos in the latest CMS-855B enrollment form, dated July 11, and two affect only the agency’s web-based Provider Enrollment Chain Ownership System (PECOS). Here’s a rundown on the four possible problems

08/08/2011

An overwhelming majority of your peers will implement electronic health records (EHRs) and attempt to meet meaningful use, with many already using EHR systems, according to an unscientific Part B News survey of 126 practices nationwide. NOTE: The survey is likely biased in favor of EHR because practices with EHRs or that are interested in them are more likely to participate.

08/08/2011

Codes with modifier 55 (post-op management only) attached have the highest denial rates of codes with modifiers, beating out modifiers unbundling E/M codes (25 for separate, significant E/M). This chart shows denial rates for high-utilization codes with modifier 55 attached in 2009 and compares them to their denials in 2005. 

08/08/2011

Your Medicare payments will not be immediately affected as a result of Congress’ debt compromise, signed into law Aug. 2, to avoid a federal default and raise the debt ceiling, but they will likely be on the chopping block later this year at the hands of a new bipartisan Congressional committee.

08/08/2011

While CMS has stated you can bill an office visit on the same day as the Annual Wellness Visit (AWV), in a recent CMS provider forum, they made it very clear that there could be no “double dipping” of the documented elements from the AWV to meet a given level of E/M. How does the prohibition on “double dipping” affect the documentation requirements for the patient’s history of the present illness, medications, past surgical history, family history  and review of systems?  What do you see as the “maximum” level of new patient E/M that could be used if the physician/practitioner fulfills the requirements of the AWV?

08/08/2011

NOTE: This story has been updated and was published in the August 15, 2011 issue of Part B News. You can read the updated story here: LINK.

You must revalidate the complete enrollment information of all providers who enrolled with Medicare before March 25, 2011. You must get this done by March 23, 2013, or face the same consequences of any late revalidation: frozen Medicare payments. CMS made it official in MLN Matters article, number SE1126, released Aug. 5. Expect to receive a revalidation notice from your Medicare contractor asking you to revalidate, CMS says. Contractors will send out notices "on a regular basis," the agency writes.

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