Summary: Some codes seeing the greatest usage growth by non-physician practitioners (NPPs) also see some of the greatest denial rates, an NPP Report analysis shows. The latest 2009 claims data from CMS reveals high denial rates for many common services, which have seen steady growth over the last few years.

Look to electronic health record (EHR) adoption and prevention care measures, such as pneumonia and influenza vaccine administration, when your non-physician practitioners (NPPs) attempt to report Physician Quality Reporting Initiative (PQRI) measures to earn bonuses. An analysis of CMS billing data shows 10 NPP specialties billed quality data codes more than 700,000 times in 2009.

You must review the "incident-to" billing of your non-physician practitioners (NPPs) in general and Part B drugs in particular, or you will risk attracting extra attention from government auditors in 2011, NPP Report has learned. The HHS Office of Inspector General (OIG) plans to examine the billing of Part B drugs that are not typically self-administered by the patient, including the use of incident-to billing by NPPs. 

This week's question is answered by Regan Bode, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services.

Q. Patient presents to urgent care or to an instant care provider (ICP). The physician does an X-ray and confirms a fracture, then applies a cast for comfort and refers the patient to orthopedics for permanent treatment. Can the ICP bill for application of the cast or just an E/M code with the codes for casting supplies?

Download the October Tool of the Month, developed by DecisionHealth Professional Services, from the Part B News. This tool will help you establish an office policy for providing medical services to your employees.

Summary: This chart shows the volume of Medicare claims billed by the highest and lowest physician specialties, defined by the average number of claims billed. Example: The average infectious disease specialist billed 10,602 services to Medicare in 2009, compared to an average of 862 services billed to Medicare by general practitioners in the same year.

The NPP Report is free to Part B News readers as part of the newsletter subscription. The October issue analyzes how NPPs are reporting quality of care codes to earn bonuses from CMS, NPP targets in the latest Office of Inspector General (OIG) Work Plan and 10 high-growth, high-denial services provided by NPPs in 2009.

Bill the unlisted special service code (99199, carrier priced) when you provide a smoking cessation service to patients who don't present with signs or symptoms of a tobacco-related disease, CMS says. CMS changed its coverage policy for the cessation services on Aug. 25, but doesn't want you to bill existing codes for it.

Physicians from around the country have told CMS they will stop treating Medicare patients if a 23% cut hits their reimbursements on Dec. 1. The 2011 Medicare Physician Fee Schedule will be finalized by Nov. 1 and the 2011 conversion factor will reflect the 23% cut and another 6% reduction scheduled for Jan. 1.