Smaller group practices will have a harder time reporting in the e-Prescribing (e-Rx) Incentive and Physician Quality Reporting System (PQRS) programs thanks to the changes CMS made in its 2012 Physician Fee Schedule (PFS) final rule, which eases large practices’ burden.

You and your peers have big problems with Medicare as a payer – lower payment rates on services, the annual cliffhanger of sustainable growth rate (SGR) cuts that depend on Congressional action, and constantly changing government rules. But Medicare can still be more valuable to your practice than private plans unless your case-mix is lopsided, experts say.

You don’t get the same benefit from all your payers, whether it’s Aetna or Medicare. While their contribution to patient volume is a big factor in value, (see main story), you must take the administrative costs of doing business with them into account, says Frank Cohen, principal and senior analyst for the Frank Cohen Group LLC in Clearwater, Fla.

Here’s a five-step guide to ranking your payers, all based on data you can pull from your practice management system and/or accounting software.

Modular electronic health records (EHRs) are basically separate parts of an EHR that you can buy cheaply – a tempting idea for practices with an older EHR that can meet some elements of meaningful use, but have a few gaps. But the modular route has a ton of risks, such as incompatibilities between products by different vendors, and less predictable support over time, experts say.

This chart looks at how much money specialties will lose on interpreting diagnostic CT, MRI and ultrasound tests that will be hit by the Multiple Procedure Payment Reduction (MPPR) in 2012. These 10 specialties were chosen because they had the highest annual payments from Medicare for billing modifier 26 (professional component) claims for the 119 imaging codes to be eligible for MPPR cuts to the professional component (PC). NOTE: To come up with estimated losses, the annual amount paid to that specialty in 2010 – the latest year of CMS data available – is used as a baseline. For each specialty, we estimated the percent of their test reads for the 119 codes that would represent multiple scans of the same patient read in the same session. These percentages were based on interviews with practice managers from the specialties, and can vary.

Is it correct for a carrier to require ACL surgery be billed with G2089?

Surgical code not required for anesthesia claims. An article in the October 24 issue of Part B News listed that a surgical code is required on all anesthesia claims. HIPAA 5010 regulations allow anesthesiologists to include the surgical code on the anesthesia claims but doing so is not a requirement, according to the American Society of Anesthesiologists (ASA) which released guidance on the matter after the article’s publication.

Your peers increasingly think of Medicare’s annual wellness visit (AWV) as a patient data-gathering and education visit, especially with the new health risk assessment (HRA) requirement. Because no physical exam is required and much of the AWV is collecting patient health information, your non-physician practitioners (NPPs) play a bigger role than physicians.

You and your peers rake in a lot of extra revenue by billing your non-physician practitioners’ (NPP) services incident-to with Medicare. But you could be taking in even more money by letting your NPPs bill under their national provider identifier despite the 15% lower reimbursement rate, experts say.