Government auditors have employed a new method to examine your claims with "heightened scrutiny." As a result, the error rate for Medicare fee-for-service (FFS) claims almost doubled from 2008 to 2009. CMS will release its Comprehensive Error Rate Test (CERT) in a few weeks, a CMS official tells Part B News. The agency says the 2009 FFS error rate will be 7.8%, which amounts to $24.1 billion in improper payments. This will be the first CERT since the 2008 mid-year report (PBN 5/25/09).

Here's my scenario: The patient had a lumpectomy and returned to the office during the 90-day global period. She had a seroma, which the surgeon aspirated. Can I bill for the procedure using modifier 58 (indicates a staged or related procedure or service by the same physician during the postoperative period)?

You're getting three additional months to enroll providers who order supplies or durable medical equipment (DME) into CMS's online enrollment system, Part B News has learned. CMS had recently issued a tough new rule requiring all providers who order supplies or DME be in its online Provider Enrollment Chain Ownership System (PECOS) or face instant denials on their DME claims starting Jan. 1, 2010 (PBN 10/26/09). Providers who refer patients to other Medicare providers or suppliers are also affected by this rule.

Whether you're using the wrong modifier or failing to use the right one, modifier errors are a common reason for denials, with modifiers 25 and 59 being two of the biggest troublemakers (PBN 3/31/08). This chart shows 10 modifiers commonly used by physicians and their denial rates from 2005 to 2008.

The AMA lists the following problems with the consultation billing rule change to support its call for more time.

So physicians and other healthcare professionals are looking at a very distinct possibility that they will soon be asked to work harder for more people and probably not make as much money. A little anxiety and outright crankiness is to be expected.

So physicians and other healthcare professionals are looking at a very distinct possibility that they will soon be asked to work harder for more people and probably not make as much money. A little anxiety and outright crankiness is to be expected.

Payers have various rating, tiering, and ranking systems that attempt to assess a physician’s performance against his or her peers. Some of these systems may be tied to reimbursement rates, but mostly they are used to steer patients
to physicians in the higher-quality tier.

Mistakes and inefficiencies can be reduced if a healthcare organization implements “Lean,” a business approach that considers customer value to be paramount, he says. Under this principle, any time or resources invested in anything else become wasteful.

You've always captured patients' names and contact information, but the more information you can get, the more likely you are to boost patient satisfaction - and collect more of what you're owed. You'll want a thorough list of the information you need, and spend the most effort on the items you deem most important. First of a two-part series.