Medical societies and physician groups strongly oppose CMS's methodology to calculate 2012 penalties for failing to adopt electronic prescribing.

CMS detailed its plans for e-prescribing penalty programs in the proposed 2011 Medicare Physician Fee Schedule. Under the proposed rule, any provider who is eligible for the e-prescribing program needs to e-prescribe at least 10 times during the first six months of 2011. Financial penalties would be levied against any eligible provider who does not e-prescribe.

The medical associations believe CMS's penalty program is off. They say providers shouldn't be penalized one year for the previous year's performance.

And, they might be right. The enabling legislation, the Medicare Improvements for Patients and Physicians Act of 2008, for the program says the penalty will apply to "covered professional services furnished by an eligible professional during 2012 or any subsequent year, if the eligible professional is not a successful electronic prescriber for the reporting period for the year."

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Physical therapists from around the country recently received comparative billing reports (CBRs) evaluating use of the modifier KX. The reports compare a provider's KX usage with his or her peers, and are for informational purposes only, says Safeguard Services LLC, a nationwide contractor running the program.

Modifier KX allows providers to bill therapy services for patients who have exceeded Medicare's physical therapy cap of $1,860 or occupational therapy cap of $1,860. Safeguard reviewed 2009 claims from 5,000 providers to see if the modifier was being used properly. The contractor says: "Physical Therapy providers are instructed to use the KX Modifier to indicate that the services that they are rendering are: (1) medically necessary and that justification is documented in the medical records, (2) the physical therapy financial limitation cap has been met, and (3) that the beneficiary's condition is such that they require further treatment."

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One of the most confusing areas of the final meaningful use rule has been a little thing called clinical quality measures (CQMs). Your peers hit CMS again and again with questions on what these are, how many of them must be met, and how they fit into the total number of meaningful use requirements needed to secure up to $40,000 in EHR incentives. Here's how this works, in a nutshell: CQMs are statistics that you report to CMS or, in some cases, to state medical agencies (read more) ...

A remarkable 42.2% of physicians say they've had a medical liability claim filed against them at some point in the career, according to a recent AMA report. More than 20% of physician respondents say they've been sued more than once. There is some good news: About 65% of the claims filed were dropped, dismissed or withdrawn, AMA researchers found. But the bad news is that defense costs are high, with an average cost of defense pegged at $40,649 and the lowest costs hovering around (read more) ...

It's finally begun: CMS's Recovery Audit Contractors (RACs) have started reviewing claims for medical necessity, though at this point only inpatient claims are being targeted. Remember: There are four permanent RACs that have jurisdiction over various regions of the country. Only one of them, CGI Technologies and Solutions, Inc., is targeting medical necessity (also known as "complex" reviews). CGI is the RAC for Region B, which covers Michigan, Minnesota, Illinois, Indiana, Kentucky, Ohio and Wisconsin (read more) ...