Your Physician Quality Reporting System (PQRS) bonus payment for services rendered in 2011 is at risk if you don’t act by Feb. 24, Part B News has learned. Seven G-codes related only to the PQRS measures were inadvertently deleted during CMS’ transition to HIPAA version 5010 last year, resulting in rejected claims, CMS says.

You can turn annual wellness visits (AWVs) into part of your revenue solution, not part of the problem, by billing Medicare for this non-deductible service repeatedly, offsetting the financial woes typically seen in the first quarter. A two-physician primary care practice in Georgia got $25,000 alone from AWVs in last year's Q1.

While it’s no fun undergoing a routine billing audit from a private payer, it’s usually just part of doing business. But your relationship with a payer can really take a nosedive if you end up investigated by a payer’s “special investigations unit” (SIU). Unlike a general payer audit, SIUs specialize in combating fraud, waste and abuse, typically launching an investigation once a larger billing problem has been identified by the payer.

This chart presents 10 heavily-billed codes along with the potential Medicare payment increase these codes would have seen nationally were it not for denials. The data labels represent 2010 potential increases, but are graphed alongside the 2009 figures as a comparison. These percentages were derived by dividing the total denial amount for each code by the total Medicare payment for that code. The resulting percentage represents how much the overall Medicare payment for the codes would have increased if zero denials were issued.

Your Physician Quality Reporting System (PQRS) bonus payment for services rendered in 2011 is at risk if you don’t act by Feb. 24. A total of seven G-codes were inadvertently deleted during CMS’ transition to HIPAA version 5010 last year, affecting 30 PQRS measures. Following is a table listing all meaures impacted by the deleted codes.

Code G0289 (surgical knee arthroscopy with surgery to remove loose/foreign body or chrondroplasty at the time of other arthroscopy on the same knee) has an N1 payment indicator which means it’s bundled into the payment for ambulatory surgical center facility fees and cannot be separately billed.  The Medicare Claims Processing Manual states that you cannot bill codes with N1 status as additional line items since it could lead to improper reimbursement.  If so, what is the purpose of G0289?

Your physician assistants (PAs) may now certify and recertify patients for Skilled Nursing Facility (SNF) services, CMS announced in a transmittal earlier this month.

Rather than wait on the physician to get back to the office to sign off on the SNF transfer, PAs can go ahead and certify on their own, facilitating a much smoother process for the practice and the patient, says Michael Powe, vice president of reimbursement and professional advocacy for the American Academy of Physician Assistants (AAPA).

This chart presents five wound care codes and their corresponding denials as a percentage of overall service count for both physician assistants (PAs) and nurse practitioners (NPs). Data was taken from 2009 and 2010. NOTE: Wound vac codes were excluded from this graph.

CMS is giving you extremely vague instructions in developing your own HRA form to add to the 2012 annual wellness visit (AWV) paperwork. Well rather than do the leg work yourself, use this tool as a template for your practice's HRA form.