Ask key questions of your practice management software vendor now to find out whether you can take advantage of a just-released final interim rule on electronic funds transfer (EFT) and electronic remittance advice (ERA). The rule, effective Jan. 1, 2014, forces payers to remove barriers and inconsistencies that cause you major EFT and ERA transaction headaches.

Eliminate days or even weeks of time it takes your providers to enroll with Medicare by uploading supporting documents to the Provider Enrollment Chain Ownership System (PECOS) website rather than sending paper copies by mail. CMS went live with this latest PECOS upgrade this month and has instructed all Medicare administrative contractors (MACs) to accept supporting documentation online.

Clustering levels of E/M services is not new but continues to be a hot topic for CMS and the HHS Office of Inspector General (OIG). Clustering means billing all of your E/M services among one or two middle-level E/M services because you reason that some will be higher and some lower and the payments will average out in the long run -- that raises two big problems for you.

Codes with similar descriptions for care plan oversight 99374-99380, physician supervision of home health services and non-face-to-face physician services 99441-99444 can make billing proper codes confusing.This chart simplifies the process of choosing the right code by breaking it down by where the patient lives, who the payer is, how much time is involved and what services the doctor performs.

These charts show the latest trends in inpatient versus outpatient services billed to Medicare per specialty, comparing 2010 ratios with 2006. All percentages come from a Part B News analysis of the latest Medicare claims data available. Inpatient services are defined as those that were billed with place of service (POS) codes 21 (inpatient hospital) or 23 (emergency room) and outpatient services were billed with POS codes 11 (office) or 22 (outpatient hospital). Note: The percentage figures refer to the share of all utilization for each specialty in a given POS. For example, cardiologists in 2010 billed 24.7% of Medicare services using POS codes 21 and 23 and 75.3% with POS codes 11 and 22.

Don’t rush the non-physician practitioner (NPP) hiring process if you want to see the intended workflow efficiencies and financial results. Thorough research of state laws and NPP credentials, complete physician buy-in and clearly delegated tasks are all necessary before you bring on these new providers.

Instruct non-physician practitioners (NPPs) to justify orders for portable X-ray services with written statements about the patient’s need to avoid denials and survive audits. CMS has proposed to expand its policy on who can order mobile X-ray services from just physicians to include podiatrists, dentists and NPPs, according to the proposed 2013 Medicare physician fee schedule.

This chart presents the denial rates of all E/M office visits appended with modifier 25 (separately identifiable E/M service), organized by both place of service (POS) code and non-physician practitioner (NPP) specialty. Data represent all 99201-99215 codes appended with modifier 25 that were billed to Medicare in 2010, the latest year available.

It’s our understanding that Medicare does not cover audiology tests without a physician’s order. But what if the patient wanted the test anyway? Would it be appropriate to bill with modifier GY (service provided is statutorily excluded from the Medicare program)? Will appending the modifier defer payment responsibility to the patient?