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Begin preparations for mass influx of newly insured patients in 2014

11/19/2012

Approach the shifting healthcare landscape proactively to accommodate the estimated 30 million newly insured patients from the Affordable Care Act (ACA) by considering hiring a new provider while also tracking your state government’s decision to implement reforms. Prepare now if you want to compete in a market with Medicaid expansion and health insurance exchanges (HIEs) adding Americans to the rolls who previously haven’t received regular care.

Avoid denials with proper cardiac catheterization billing, coding

11/19/2012

by: Karen Long

When billing left heart catheterizations, get an addendum from the doctor if he didn’t document that he passed a catheter through to the left side of the patient’s heart. It can mean the difference between getting paid and being denied.

Benchmark of the Week: Discharge management utilization by specialty, 2011

11/19/2012

by: Ben Penn

This chart presents the top 14 specialties in the order of most discharge management utilization to least. The data come from a Part B News analysis of 2011 Medicare claims data. All service counts are derived from a combination of hospital discharge management codes (99238-99239) and nursing facility discharge management codes (99315-99316). Note: The final 2013 Medicare physician fee schedule created new CPT codes for transitional care management (TCM) in the 30 days following a discharge from a hospital or skilled nursing facility. As explained below, these codes will be strongly correlated with the TCM codes in 2013.

2013 fee schedule’s post-discharge care codes could boost payments, shift workflow

11/12/2012

by: Ben Penn

Primary care providers stand to reap the most benefits from new CPT codes for transitional care management (TCM) following a discharge. The codes are featured prominently in the final 2013 Medicare physician fee schedule. Depending on the complexity of your medical decision-making (MDM) and the timeframe of a face-to-face visit, you will receive $121 or $170 for TCM services based on the non-facility rate and the new conversion factor of $25.0008.

Cardiology, ophthalmology, group practices suffer blow from newest MPPR cuts

11/12/2012

by: Lauren C. Williams

Cardiologists, ophthalmologists and group practices will see pay cuts for taking and reading imaging tests thanks to CMS’ latest expansions to the multiple procedure payment reduction (MPPR) in the final 2013 Medicare physician fee schedule.

CMS gives more time to avoid payment cuts, adds 2 new e-Rx exemptions

11/12/2012

by: Karen Long and Laura Evans

You have more time to apply for e-prescribing exemptions to avoid the 1.5% cut to allowable fees for not participating in Medicare’s incentive program (e-Rx). In addition, the agency has added two new hardship exemptions in the final 2013 physician fee schedule to excuse providers from e-prescribing if they achieve meaningful use or plan to.

Physician fee schedule: Payment modifier applies only to large groups in 2015

11/12/2012

by: Ben Penn

The value-based payment modifier won’t kick in until 2017 unless your practice employs 100 or more providers, CMS states in the final 2013 Medicare physician fee schedule. The modifier will adjust all physicians’ payments depending on how they improve care and reduce costs compared with others in their region and specialty.

2013 fee schedule brings new rules for CRNAs, DME, drugs, outpatient therapy

11/12/2012

by: DecisionHealth editorial staff

Here’s a round-up of other items from the final 2013 Medicare physician fee schedule, released Nov. 1, that affect your practice. (Note: Part B News has provided the page numbers and a link so you can read that piece of the rule at http://pbn.decisionhealth.com/Resources/GetFile.ashx?FileId=100775.)

Benchmark of the Week: Part B News' 5-year payment analysis

11/12/2012

by: Lauren C. Williams

Track your payment changes for imaging services and office visits from 2009 through 2012 and your prospective payments for next year based on relative value unit (RVU) changes listed in the final 2013 Medicare physician fee schedule.

Final 2013 fee schedule released: Physicians paid to coordinate care

11/05/2012

by: Part B News staff

Primary care physicians will get a 7% pay increase and other providers will see bumps between 3% and 5% in 2013, according to the final 2013 Medicare physician fee schedule released late Thursday. The 26.5% sustainable growth rate (SGR) cut that would offset those increases on Jan. 1 will likely be delayed again, CMS said in a statement.

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