This chart examines a total of 20 modifiers, 10 of which had some of the highest denial rates in 2010 and 10 which had some of the lowest, comparing their 2010 rates with 2009. NOTE: Because 2010 was the first year in which CMS no longer accepted consult codes (99241-99255), the new modifier AI (principal physician of record). Thus, there is no 2009 data for this modifier, which is added to inpatient claims billed by the admitting physician. Adding modifier AI lets contractors know the services were furnished by the admitting physician who coordinates care, distinguishing them from services done by others who also see the patient.

CMS Administrator Donald Berwick, M.D., will officially resign his post effective Dec. 2, CMS says. News of the departure leaked Nov. 23 before CMS’s formal announcement. Berwick will be succeeded by Marilyn Tavenner, currently CMS’s principal deputy administrator, who has previously acted as administrator.

What is the correct way to code multiple trigger joint injections into the same site? Our physician gave patient 10 injections and we billed 20610 (arthrocentesis, aspiration and/or injection; major joint or bursa) times 10 units along with 1 unit of the medication and the claim was denied.

You have six weeks to clear out the rest of your outstanding 2011 accounts receivable, and that means either sending balances to collections or writing them off as bad debt. You’ll want to start 2012 with a clean slate, and clearing out the A/R will also let you compile more accurate yearly benchmark data on your practice’s financial performance, experts say.

Smaller group practices will have a harder time reporting in the e-Prescribing (e-Rx) Incentive and Physician Quality Reporting System (PQRS) programs thanks to the changes CMS made in its 2012 Physician Fee Schedule (PFS) final rule, which eases large practices’ burden.

You and your peers have big problems with Medicare as a payer – lower payment rates on services, the annual cliffhanger of sustainable growth rate (SGR) cuts that depend on Congressional action, and constantly changing government rules. But Medicare can still be more valuable to your practice than private plans unless your case-mix is lopsided, experts say.

You don’t get the same benefit from all your payers, whether it’s Aetna or Medicare. While their contribution to patient volume is a big factor in value, (see main story), you must take the administrative costs of doing business with them into account, says Frank Cohen, principal and senior analyst for the Frank Cohen Group LLC in Clearwater, Fla.

Here’s a five-step guide to ranking your payers, all based on data you can pull from your practice management system and/or accounting software.

Modular electronic health records (EHRs) are basically separate parts of an EHR that you can buy cheaply – a tempting idea for practices with an older EHR that can meet some elements of meaningful use, but have a few gaps. But the modular route has a ton of risks, such as incompatibilities between products by different vendors, and less predictable support over time, experts say.

This chart looks at how much money specialties will lose on interpreting diagnostic CT, MRI and ultrasound tests that will be hit by the Multiple Procedure Payment Reduction (MPPR) in 2012. These 10 specialties were chosen because they had the highest annual payments from Medicare for billing modifier 26 (professional component) claims for the 119 imaging codes to be eligible for MPPR cuts to the professional component (PC). NOTE: To come up with estimated losses, the annual amount paid to that specialty in 2010 – the latest year of CMS data available – is used as a baseline. For each specialty, we estimated the percent of their test reads for the 119 codes that would represent multiple scans of the same patient read in the same session. These percentages were based on interviews with practice managers from the specialties, and can vary.

Is it correct for a carrier to require ACL surgery be billed with G2089?