CMS overlooked some key provider issues in its proposed rule for stage 2 of CMS’ Electronic Health Records (EHR) Incentive Program, according to comments by physician advocacy groups on the meaningful use rule.

This chart shows the utilization of each E/M service level for established patient office visits in 2001 through 2010. Located in the HHS Office of the Inspector General’s (OIG’s) recent report, Coding Trends of Medicare Evaluation and Management Services, the data is based on PBAR National Procedure Summary files. The data represent the percentages of E/M services billed for established patient office visits that were billed for each E/M code (99211-99215). The number above the 10-year set of percentages for each code is the difference in code utilization from 2001 to 2010.

Physicians who successfully attested to meaningful use in 2011 performed similarly on the mandatory “core” measures and often chose the same menu measures to meet the CMS requirement of 20 reported measures (15 core, five menu). Primary care practices were by far the specialty with the most attestations, making up 41% of attesting practices in 2011, and they differ from other specialties on measures reported, according to a Part B News analysis of 2011 CMS attestation data, the latest available. A total of 28,954 physicians attested under the Medicare program in 2011; another 15,060 have attested in 2012.

How do you bill diagnostic services that fall under consolidated billing? Do you bill Medicare Part B for the professional component and Part A for the technical component, or do you identify Part A patients and only bill Part B using modifier 26(professional component)? Also, is it fraudulent for a skilled nursing facility (SNF) to have providers bill Part B global and when the technical component is denied, reimburse the SNF once we provide them with the remittance advice?

Your doctors may get a break from hospital rounds, thanks to a CMS rule that grants non-physician practitioners (NPPs) the same hospital privileges. The hospital and critical access hospital reform final rule, released May 9, counts NPPs such as advanced practice registered nurses (APRNs) and physician assistants (PAs) as part of medical staff giving them the power to use their licensed skills in hospitals.

A recent report from the HHS Office of the Inspector General (OIG) showing a rise in higher-level E/M coding selection over the past decade includes nurse physician practitioners (NPPs) among the possibly suspicious physicians who consistently bill a level 4 or level 5.

This chart shows the breakdown of specialties among the nearly 1,700 physicians who billed either a level 4 or level 5 for at least 95% of all their E/M codes in 2010. The 1,700 consistently high-billing doctors were chronicled in an HHS Office of the Inspector General (OIG) report released this month.

You have less than two months until your private payers and CMS stop accepting non-compliant HIPAA 5010 claims. Maintain cash flow and prove your practice is 5010-ready by the June 30 enforcement deadline with documented communication from your payers and clearinghouses.

Rather than wait for ICD-10 to make documentation enhancements vital for the new code set, start those changes now to improve your practice’s private payer reimbursements.

Private payer contracts are changing to reflect the severity of your patients in two key ways: