Reassess the way you balance bill members of private payers when you’re an out-of-network provider. More states than ever are taking action to restrict or regulate the practice. Balance billing occurs when you charge a patient the difference between your provider’s usual charge and what the patient’s insurer paid you for the service. The use of balance billing by physicians has long been a subject of controversy.

You are not alone if you must ask your private insurance companies to authorize a diagnostic imaging test before you render it to your patient. There’s been an uptick in private payers screening cardiology and other imaging services before allowing them to be performed on the patient, some experts tell Part B News. But a quick chat with your patients’ carriers could get you paid faster and cut down unnecessary administrative legwork.

In addition to your payer being reluctant to allow imaging tests without proper authorization, there are some cases they will demand you perform imaging tests as a condition of pre-authorization for surgical treatment, adding to the confusion.

You face a hefty $505 per-provider fee as of March 25 when you enroll in Medicare as a supplier, even when you are revalidating an existing enrollment. Any physician or non-physician practitioner (NPP) practice that provides durable medical equipment (DME), prosthetics, orthotics and supplies to beneficiaries that are billed using DME codes and are paid on the DME fee schedule needs to be enrolled as a DME provider, and they will be affected by the $505 fee if they are newly enrolling as a DME provider or if they are revalidating their DME enrollment, experts say.

Electronic health records (EHRs) are still the exception rather than the norm at small and mid-sized physician practices across the country. For practices still on paper, the cost of buying an EHR remains the biggest barrier to entry, with nearly 72% citing the difficulty of getting startup cash as their biggest concern. This chart analyzes the payment methods used by practices that had EHRs as of 2010. NOTE: All data cited, including the above references to perceptions of barriers to entry, come from a recently released nationwide survey conducted by the Medical Group Management Association (MGMA). The MGMA survey received responses from more than 4,500 practices across the country.

Our office has started to perform and bill for the new Medicare Annual Wellness Visit (G0438) but we’re confused on what diagnosis code to report. Some in our office say it should be the problems we find during the visit, others say we should use diagnosis code V70.0 for a general preventive screening. What is the Medicare requirement?

Prepare to defend any of your codes affected by National Correct Coding Initiative (CCI) edits against CMS’s recovery audit contractors (RACs), which have begun using the edits as targets for overpayment demands. Two cases in Pennsylvania – a major integrated delivery system called WellSpan Health and a much smaller urology practice – offer evidence that you must pay close attention to CCI changes.