Those of you in Ohio and Kentucky received startling news from your Medicare administrative contractor (MAC) – Cigna Government Services (CGS) – last month that examination must always be documented on an established patient E/M note, regardless of the level.If CGS is your MAC and you receive an E/M denial for that reason, mount an appeal, experts say.

Avoid becoming a high-billing practice suspected of inappropriate level 4 and level 5 selection by conducting thorough internal audits of your E/M services. If you have an electronic health records (EHR) system, your physicians are especially prone to improper E/M billing.

Cloned E/M notes on electronic health records (EHR) are one of the top reasons you could be over-billing for E/M levels 4 and 5, and they put you at risk of losing payments in a review. EHR experts see that as a frequent cause of inaccurate and medically inappropriate E/M visit notes created by doctors with good intentions. Even worse, the vendors will frequently promote cloned notes as a product benefit.

Your providers’ $18,000 meaningful use bonuses could be at risk, even if you’ve conducted a security risk analysis (SRA) to comply with HIPAA. While you’re already required to follow security standards for electronic health information, an SRA asks providers to implement security updates and correct security deficiencies as needed.

A final rule implementing new penalties of up to $1.5 million per HIPAA violation could be issued as early as this month, so evaluate how well your practice keeps patient records safe from privacy and security breaches to protect your revenue.

Is there an ICD-9 code to replace code 518.5(Pulmonary insufficiency following trauma and surgery) that was deleted in September 2011?

This chart depicts the percentage of physicians within the selected specialties who e-prescribed in 2011. The data are based on an analysis of nearly 315,000 office-based physicians conducted by Surescripts, an Arlington, Va.-based company that provides e-prescribing services to the health care industry.

Conduct an internal cost analysis of your Medicaid patients to determine whether you could receive double the reimbursement for primary care services to them in 2013 and 2014. A CMS proposed rule would bump Medicaid rates to at least Medicare levels for those two years, providing $11 billion in federal funding under health reform to bolster state Medicaid programs.

Do not read too much into an HHS Office of the Inspector General (OIG) report released this month that shows an increase in high-level E/M billing over the past decade. The report shows no evidence of improper billing, and only a small number of extremely high-billing practices are likely to face a Medicare administrative contractor (MAC) review as a result.

Prepare to manage more part-time physicians as doctors strive for work-life balances and seek more traditional employee-employer relationships, moving away from long hours spent building practices. Many younger doctors are shying away from putting in 80-hour work weeks to start their businesses.