While CMS is still months away from finalizing its proposed rule on accountable care organizations (ACOs), it’s already moving to make the ACO concept easier to swallow. A new department of CMS, called the Center for Medicare and Medicaid Innovation, announced three ACO-related initiatives.

Q. For determining medical decision-making, level-of-risk and management options, if a physician writes a prescription for a patient for a medication that can also be obtained over the counter is this considered “prescription drug management” or over the counter drugs?  For example, a prescription is written for 800 mg Motrin, which the patient can take over the counter at the same dosage.

It could be a little harder for your non-physician practitioners (NPPs) to meet their quota and avoid the 1% cut to Medicare payments in 2012 if your practice is not set-up for e-prescribing due to a combination of some practices lack of preparedness and providers being numbed with information. “This stuff is painful, so people tend to ignore it until it’s too late,” she says of the hoards of providers fretting about meeting their e-script quota in just days. 

You and your peers lost $88.9 million to denials on chiropractic manipulation services in 2009, down from $115 million in 2007. While the average denial rate for codes 98940-98942 has fallen from 13.3% to 10.8%, chiropractic manipulative treatment (CMT) remains a stubborn trouble spot for a specialty that earns a sizeable chunk of Medicare revenue among non-physician practitioners (NPPs).

Not all providers are required to e-prescribe but knowing  your NPPs’ prescribing responsibilities can help your practice avoid the 1% payment hit in 2012.

Both nurse practitioners (NPs) and physician assistants (PAs) bill the majority of their Medicare services in the office setting, though NPs split the rest of their utilization between nursing facilities and skilled nursing facilities (SNFs). PAs split the rest of their utilization on the emergency room, and inpatient hospital. Neither spend much time in ambulatory surgical centers or end-stage renal disease (ESRD) facilities.

We have a PA-C working in our office. Claims for this NPP are billed incident to our physician. On a recent audit of these, the auditor stated the services rendered did not meet the criteria for incident to billing, as the PA-C was dealing with "new" problems, not outlined in the physician’s plan of care. When I look at the PA-C's note, I see a routine follow-up for chronic conditions. Are we missing something these auditors are looking for?