Your practice may be losing thousands of dollars because of low reimbursement rates from private payer fee schedules. Ask your payers for complete fee schedules every year to avoid falling in that trap. Without seeing the fee schedule, practices can’t make educated decisions as to whether the “updated” rates are higher or lower than before.

Physicians will check a box labeled “all others negative,” intending to indicate that the patient had no other complaints so other systems were not reviewed. But that type of checkbox indicates that the physician did review the rest of the systems, overstating in the documentation the work the doctor actually did, says Regan Tyler, CPC, senior consultant for DecisionHealth Professional Services.

If you aren’t scheduling annual wellness visits (AWVs) for your Medicare patients, you’re not only missing out on revenue for those visits but also losing a perfect opportunity to schedule future visits for five reimbursable preventive services.

The questions physicians or non-physician practitioners (NPPs) ask during AWVs inform them which patients are applicable for screenings at separate visits. That makes it simple to schedule the screenings for multiple patients.

Your revenue is at risk with Medicare poised to automatically filter claims for errors related to new versus established patients. Too many mistakes could look like abusive billing or intentional ignorance about coding rules.

New patient visits pay more than established visits of the same level, but if you bill a new patient with a lower-paying established patient code, you’ll miss out on revenue you’re owed.

This chart shows the volume of Medicare claims billed by physicians who billed the most and least often, defined by the average number of claims billed per provider within that specialty. Example: The average cardiologist billed 5,053 Medicare claims in 2010. Note: The first seven specialties had the highest Medicare volume in 2010, while the last seven specialties had the lowest volume. Note: These figures were calculated by dividing the total number of services billed by all providers in a specialty into the number of individual physicians enrolled in each specialty, according to Medicare claims and provider enrollment data from 2010.

A physician at an internal medicine practice performs percutaneous allergy tests and faxes prescriptions for allergy serum, or antigen, to a vendor organization that prepares it. The patient then receives injections at our office. The initial set of injections usually consists of five vials of multiple antigens of different dilution intervals. The vendor that prepares the serum bills our practice, and we charge the patient. How do we bill Medicare for that so the patient’s serum can get reimbursed? Code 95144 is used for preparing the serum, but it’s unclear how to do it in that scenario because the vendor, which does not have its own billing services, does it on our behalf. How can we bill this service in a way that reduces the patient cost?

Encourage your hospitals to expand services provided by non-physician practitioners (NPPs) using a recent CMS rule that endorsed NPP hospital privileges as leverage. But make sure your NPPs abide by the hospital’s bylaws, experts say.

The hospital and critical access hospital reform final rule, published in the May 16 Federal Register, counts NPPs, such as advanced practice registered nurses (APRNs) and physician assistants (PAs), as part of hospital medical staff giving them the power to use their licensed skills in hospitals.

Don’t get caught off guard when self-pay patients show up at your front desk not prepared to pay an outstanding balance or for the current visit. Instead, develop a clear policy on how to approach those patients to maintain collections and ensure you won’t be accused of violating a payer contract when a patient lies about insurance status.

Don’t wait for your hospital to approach you and coordinate billing for the three-day payment window. Prepare your practice by establishing a clear line of communication with your hospital and holding claims to avoid overpayments. The three-day payment rule, effective July 1, mandates lower reimbursement for providers at practices that are wholly owned or operated by a hospital when a patient is admitted within three days of receiving clinically related services from the practice (PBN 6/18/12).

If your practice is overwhelmed with mounting regulatory deadlines, claims billing, coding, staffing and other practice management duties, outsource some tasks to a local management services organization (MSO) after a vigilant vetting process.