How do private payers stack up compared to each other and to Medicare? This chart looks at two key metrics of payer performance: first, how closely the amount on the first electronic remittance advice (ERA) tracks with the fee schedule amount expected by the provider, and second, how many days pass between claim submission and the first ERA. NOTE: All data comes from the AMA’s recently released 2011 National Health Insurer Report Card.

Expect very few changes in the most recent Correct Coding Initiative (CCI) edits, version 17.2, which took effect July 1. There are a total of 2,703 changes, just over a fifth of the 12,192 changes from version 17.1 (PBN 4/4/11), an exclusive Part B News analysis shows. Nearly half of new code pairs are HCPCS (49%), most of which are G-codes, followed by surgery codes taking up almost a quarter of the new pairs (24%).

You will see very few additions but several removals that made their way onto CMS’s Average Sales Price (ASP) list for the third quarter. In comparison to the second quarter, drug prices remained stable and prices for the top Part B drugs increased by 0.8% on average. Prices changed 2% less for 25 out of the top 50 higher-volume drugs with 14 of the top 50 drugs seeing decreases, CMS says in an online statement accompanying the report.

Can an ultrasound technicians trained and certified to perform cardiac studies do so on-site, bill for the test globally and then pay a radiologist to interpret the tests at a set per-study rate?

You may be getting a reprieve back to Oct. 1, 2011 if you have physicians who qualify for new exemptions to the e-prescribing (e-Rx) requirement that were proposed in the May 26 Federal Register. CMS officials highlighted a key provision in the proposed rule, that you will have until Oct. 1 instead of June 30 to report exemptions introduced in it, during a June 21 open door call. But it all depends on what makes it into the final rule.

Your primary care physicians can potentially collect a $21,250 incentive check without having to meet meaningful use requirements in 2011 or 2012, under the Medicaid Electronic Health Record (EHR) Incentive Program. The catch is that a provider’s patient mix must be 30% Medicaid to qualify for the bonus. But you can shift your Medicaid patient caseload to a one doctor, potentially boosting his Medicaid volume to 30%.

Good news! It is possible for your providers to each write 10 unique e-prescriptions by the e-prescribing (e-Rx) June 30 deadline to avoid the 1% hit to your Medicare payments in 2012. The fastest way to get from zero to 10 unique e-prescriptions is through an online service, says Helen Phung, a spokeswoman for Practice Fusion, which offers a free online e-Rx service. With Practice Fusion and other online e-prescribing services such as AllScripts and DrFirst.com, providers can meet the deadline in record time.

Cardiologists, orthopedic surgeons and internists saw the biggest percent gains in compensation from 2009 to 2010, while ophthalmology and family practice without OB/GYN took the biggest hits. The single biggest gainer was invasive/interventional cardiology with 6.2%. The overall gains were small than the gains from 2008 to 2009, which saw dermatologists, orthopedic surgeons and ENT physicians leading the pack .

You and your peers are in the last days to meet the ominous e-prescribing (e-Rx) deadline that could hold 1% of your 2012 Medicare payments hostage if you fail to e-prescribe to 10 unique patients by June 30 or apply for one of the finalized exemptions. Part B News has compiled a list of the top e-Rx stories with vital tips to aid you in the mad dash for the finish line:

You and your peers won’t have many good reasons to participate in accountable care organizations (ACOs) unless CMS makes big changes to its proposed ACO rule, according to four major provider advocacy groups. “The current requirements proposed for acceptance as an ACO by Medicare under this program sets too high of a bar for participation by many internal medicine physicians, especially [those] who practice in smaller, independent physician practices,” writes the American College of Physicians.