Practices that refill and order durable medical equipment (DME) for patients will have more paperwork to complete and send to suppliers if CMS finalizes its proposal in the 2013 Medicare physician fee schedule. Non-physician practitioners (NPPs) can conduct the face-to-face visit, the order won’t get approved without a doctor’s sign-off.

Familiarize yourself with the Physician Quality Reporting System (PQRS) in the second half of 2012 to prepare for 2013 reporting and avoid the 1.5% penalty in 2015 based on 2013 data. You’ll also receive a 0.5% Medicare payment increase for successfully reporting in 2013 and 2014.

The biggest concern in a recently released HHS Office of Inspector General (OIG) report on Medicare E/M coding trends – finding that certain physicians consistently bill higher E/M levels than their peers – is that it mirrors what we see in client audits all the time.

Palmetto: AQ modifier errors on the rise, check updated HPSA locations. Some states had a 100% error rate for provider use of the AQ modifier (Physician providing a service in a health professional shortage area [HPSA]) in the first quarter of 2012, Palmetto tells Part B News. During most quarters, that figure is 25%.

This chart examines physician interest in accountable care organizations (ACOs) and patient-centered medical homes. Data are based on more than 2,500 physician responses to a survey conducted this year that was published in the 2012 Medical Practice & Attitude Report by Jackson Healthcare, a healthcare staffing company in Alpharetta, Ga. Respondent interest, separated by practice type, classifies physician interest level by four categories: participating in an ACO or medical home in 2012, considering participating, not participating or considering and doesn’t know.

Can a provider dictate a discharge summary the day before the patient is discharged from a hospital or facility and receive credit for it?

CMS is weighing several options and seeking comments on how to construct, verify and submit documentation for its proposed face-to-face requirement for durable medical equipment (DME) orders (see related story). Review the graph below to see CMS’ different scenarios. CMS does not plan on adopting every option listed and wants your input on the proposed policies and any alternatives. Comment on CMS’ proposals at www.regulations.govby Sept. 4 under CMS-1590-P.

Non-physician practitioners (NPPs) are included in a major component of the proposed 2013 Medicare physician fee schedule that would create a new G-code for primary care practices to receive additional payment for post-discharge transitional care management.

This G-code, which would pay a work RVU of 1.28 on top of the E/M office visit, would cover non-face-to-face services provided by community physicians and NPPs in the 30 days following a facility discharge.

A provision in the proposed 2013 physician fee schedule would end denials of pain management services provided by certified registered nurse anesthetists (CRNAs), but don’t assume this portion of the rule is a done deal. Anesthesia practices should take advantage of the comment period to submit their support for this portion of the rule.