Medicare won't pay for an audiologist's services that are billed under a physician's National Provider Identifier (NPI) number, CMS clarifies in a transmittal to its payment policy manual. Historically, audiology services could be billed incident to a physician's services until Medicare changed its billing rules in 2008. CMS then required audiologists to have their own NPI (PBN 7/28/08). You may have been unclear with how to bill some patient scenarios you've encountered since then, but CMS is now clearing the air on its audiology billing policy.

The number of non-physician practitioners (NPPs) participating in Medicare has risen steadily over the last four years, growing at nearly four times the rate of physicians, an NPP Report analysis of CMS enrollment data shows. From 2006 to 2009, the number of nurse practitioners (NPs) and physician assistants (PAs) enrolled in Medicare increased by 7.5% and 7.2% respectively, compared to an average of 2.2% for physicians across all specialties.

This week's question is answered by Regan Bode, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services.  

Q: I have a radiologist who specializes in mammography and she is the director of breast imaging at a free standing facility in New Jersey. The company would like to offer genetic counseling when necessary. Licensure has been approved, but we don't have a license in place at the moment. Genetic counselors get NPI numbers. Is it possible to bill the service as an E/M under the radiologist, if she is present and has an order from the gynecologist for genetic counseling? Or does the genetic counselor bill 96040 under her name and NPI? 

Summary: This chart examines denials from a per-provider angle, looking at how the major non-physician practitioner (NPP) specialties fare when it comes to denials and the revenue they cost. NOTE: The number of denials is an average, calculated by dividing the number of denials into the number of providers enrolled in each specialty. The dollar cost of denials is also an average, derived from the average payment to each specialty, multiplied by the number of denials per provider. Denials are an average of denials for all codes billed in 2008.

My doctor insists that we bill all of the services that used to be inpatient consults as initial hospital care codes. But I don't think some of the visits meet the requirements for those services and I'm concerned that will come up in an audit. He says that CMS knows that because consults are no longer covered there will be more initial inpatient billing. Is this allowed?

Prices for electronic health record (EHRs) systems are based on many factors, starting with whether they use the client-server model or the application provider (ASP, see story) model. Here's how EHR fees typically break down for both client-server and ASP systems.

Download the June Tool of the Month from the Part B News online Hot Documents library. The tool is a form letter to help you challenge underpayments when a discount has been wrongly applied to your reimbursement (see story). This letter is based on one developed by attorney Robin Fisk, of Ashland, N.H.

This chart assigns a per-provider denial amount, in dollars, by assessing how often each specialty has denied claims and how many providers belong to the specialty.

Medicare providers in North Carolina, South Carolina, Virginia and West Virginia won't have to worry about the chances of a disruptive Medicare Administrative Contractor (MAC) transition anytime soon. A protest has been filed against the award to Palmetto for the MAC contract to oversee those states in Jurisdiction 11 (PBN 6/7/10).

In one month, a Medicare carrier denied a quarter million claims just because billers left off critical referring information to reimburse services. The offense: Your peers neglected to attach the referring provider's name and/or National Provider Identifier (NPI).