Be on the lookout for clauses in your managed care contracts that require you to accept from the payer the lowest rate you give any other payer. These provisions, known as most favored nation (MFN), cost-containment or prudent buyer clauses, restrict your ability to contract with other payers and force you to get paid less - sometimes a lot less - than you had originally agreed to when you signed the contract.

You stand to earn up to $174.78 for every single Medicare patient whose a member of your practice next year, and $116.52 for them every year afterward (assuming there is no pay cut) - all thanks to the annual wellness visit (AWV). Your providers will have to perform one additional element during the visit to earn the money, but they'll also be able to bill related preventive services more efficiently because of changes in the final 2011 Physician Fee Schedule (PFS).

A practice inadvertently submits G8553 (at least one prescription created during the encounter was generated and transmitted electronically using a qualified electronic prescribing system) on claims during the 2010 E-prescribing Incentive Program year. The practice later discovers it did not have the required certified or qualified e-prescribing system. What do you do next?

Download this month's tool - an Annual Wellness Visit Encounter Form brought to you by DecisionHealth Professional Services - to help you efficiently provide Medicare's new annual wellness visit service. 

Denials cost practices more money in 2009 than 2008, and specialties that perform high-value procedures top this chart of dollar losses per provider. This data shows the 10 specialties that saw the greatest per-provider dollar losses to denials in 2009 and compares their losses to 2008.

I read your Oct. 25 story on the new observation codes for 2011 (PBN 10/25/10). The new codes 99224-99226 are said to be used as  subsequent observation care between 99218-99220 (which to me makes sense) and codes 99221-99223 which are inpatient codes (this doesn't make sense to me). Why wouldn't we continue to use 99231-99233 for subsequent inpatient hospital care?

CMS will ask you to collect more money upfront from your Medicare patients in 2011. The Part B deductible will be $162 next year, a 4.5% increase from the current rate of $155. TIP: Remind your patients when scheduling appointments to be ready to pay the $162 deductible after Jan. 1. Several of your peers reported difficulties collecting the amount earlier this year after the deductible had jumped nearly 15% (PBN 2/1/10).

Your non-physician practitioners (NPPs) have an opportunity to boost revenue significantly thanks to provisions in the final 2011 Physician Fee Schedule (PFS) aimed at strengthening primary care services for seniors, an NPP Report analysis shows.

The 2011 Medicare Physician Fee Schedule had one silver lining for therapy providers. The Multiple Procedure Payment Reduction (MPPR) will slash the practice expense (PE) of subsequent therapy services billed on the same day by 25% instead of the proposed 50% (PBN 11/08/10).

The top two non-physician practitioner (NPP) specialties have similar denial rates for the services they bill most frequently, an NPP Report analysis shows. Nurse practitioners (NPs) and physician assistants (PAs) had almost the same average denial rate for their top codes in 2008, but while NPs lowered their denial rate in 2009, PAs saw their average denial rate increase.