Part B News | Part B News

Success of Obama insurance “fix” may depend on insurer response

11/25/2013

On Nov. 14, President Obama announced a fix to a perceived problem with the Affordable Care Act (ACA) that caused some health insurance customers whose plans were not “grandfathered” under the law to be changed by their insurers, in contradiction to the “If you like your plan, you can keep it” promise on which Obama campaigned.

Doctor-manufacturer deals under scrutiny after drug settlement

11/25/2013

by: Marla Durben Hirsch

Providers will see heightened scrutiny of their relationships with pharmaceutical and medical device manufacturers in light of one of the largest health care fraud settlements in history. Johnson & Johnson (J&J) agreed to pay $2.2 billion in civil and criminal penalties and the government is cracking down.

Be wary of bundling, documentation when billing debridement codes

11/25/2013

by: Scott Kraft

Chronically high denial rates for debridement services are likely the result of incorrectly measuring how much tissue was debrided when those services are bundled and billed the same day. Denial rates for debridement codes average 10.5%, but when you exclude the two highest-volume codes, the denials spiked to 17.1%.

Write and implement a whistleblower policy that protects employees, practice

11/25/2013

by: Roy Edroso

Protect your practice with a clear whistleblower policy that shows you’ve done due diligence to prevent wrongdoing, and make sure your staff understands and internalizes that policy.

Benchmark: Initial and subsequent nursing facility E/M code use on the rise since 2010

11/25/2013

by: Scott Kraft

Billing for initial and subsequent patient visits rendered in skilled nursing facilities (SNFs) and nursing facilities (NFs) has seen a significant lift in recent years. However, denial rates for initial visits (99304–99306) dipped, while denials for established codes (99307–99310) are tracking up, according to a Part B News analysis of Medicare billing data from 2010–2012.

Tighten patient scheduling gaps to avoid both no-shows and floods of visits

11/18/2013

by: Roy Edroso

Is poor scheduling costing you patients and income? A couple of basic investigations should help you plug the gaps. Everyone knows that scheduling snafus make for an unhappy waiting room. But they can also cost you a surprisingly large amount of money -- thousands of dollars at a typical practice, experts estimate.

Recruiting: how to hire the right physician for your practice

11/18/2013

by: Roy Edroso

You can recruit physicians to your practice with minimal outside help — but be careful of legal issues, and make sure your new doc is a good fit.

As we mentioned in our study of non-clinical hiring for practices, it’s a seller’s market for medical talent these days, with or without an MD. That makes things tough for practices that lack a human resources budget.

Arthritis drugs move to self-administered list; watch for denial increase

11/18/2013

by: Scott Kraft

If you’re seeing denials for three commonly used injectable drugs to treat arthritis, a little-noticed policy change from your Medicare Administrative Contractor (MAC) may be to blame. An increasing number of MACs have moved the drugs to the list of those usually self-administered by the patient, making them ineligible for reimbursements under Part B.

CMS clarifies: employee with permission can act as surrogate within PECOS system

11/18/2013

by: Scott Kraft

You’re not restricted to using certain individuals within your practice to act as surrogates for your providers under the Provider Chain Ownership Enrollment System (PECOS) system surrogate program that went live Oct. 7. Any individual granted permission by an authorized or delegated official of a group practice can access any individual provider record within that group, a CMS official confirmed.

eRx “informal review” period begins, but notifications not seen

11/18/2013

by: Roy Edroso

You can start contesting CMS’ ruling that you didn’t qualify as an eRx provider now — though you probably won’t, since CMS appears not to have sent notifications to people who will need to. This year’s e-prescribing deadline was June 30, and it is expected that some providers will have failed to meet the qualifying criteria or exemptions, which would subject them to a 2% cut in 2014.

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