Part B News
Five big ideas from WellPoint's PCMH pilot
12/01/2012

by Margaret Dick Tocknell

Determine feasibility of billing transitional care management codes in 2013
11/19/2012
by: Ben Penn
Assess the post-discharge services you provide and document to see whether the additional work needed to bill Medicare’s new CPT codes for transitional care management (TCM) would be worth the revenue. Timeline requirements and bundling of the first face-to-face visit into the overall payment might prompt practices to use E/M office visit codes instead.
 
Medicare adds modifiers 24, 57 to correct coding initiative bypass list
11/19/2012
by: Julia Kyles
A change to National Correct Coding Initiative (CCI) modifiers could open new revenue opportunities with private payers that follow Medicare’s CCI edits. Two global period modifiers – 24 (Unrelated E/M service by the same physician during the post-operative period) and 57 (Decision for surgery) – will be added to the list of CCI-associated modifiers next year, according to Medicare transmittal 1136.
 
New DME face-to-face requirement adds more documentation, time to E/M visits
11/19/2012
by: Lauren C. Williams
Practice physicians will have to fill out documentation for non-physician practitioners’ (NPPs’) work for certain durable medical equipment (DME) orders starting July 1, according to CMS’ final 2013 Medicare physician fee schedule. The DME face-to-face requirement is the latest Affordable Care Act-mandated effort to reduce fraud and waste among DME prescribers and suppliers.
 
Begin preparations for mass influx of newly insured patients in 2014
11/19/2012
by: Ben Penn
Approach the shifting healthcare landscape proactively to accommodate the estimated 30 million newly insured patients from the Affordable Care Act (ACA) by considering hiring a new provider while also tracking your state government’s decision to implement reforms. Prepare now if you want to compete in a market with Medicaid expansion and health insurance exchanges (HIEs) adding Americans to the rolls who previously haven’t received regular care.
 
Avoid denials with proper cardiac catheterization billing, coding
11/19/2012
by: Karen Long
When billing left heart catheterizations, get an addendum from the doctor if he didn’t document that he passed a catheter through to the left side of the patient’s heart. It can mean the difference between getting paid and being denied.
 
Benchmark of the Week: Discharge management utilization by specialty, 2011
11/19/2012
by: Ben Penn
This chart presents the top 14 specialties in the order of most discharge management utilization to least. The data come from a Part B News analysis of 2011 Medicare claims data. All service counts are derived from a combination of hospital discharge management codes (99238-99239) and nursing facility discharge management codes (99315-99316). Note: The final 2013 Medicare physician fee schedule created new CPT codes for transitional care management (TCM) in the 30 days following a discharge from a hospital or skilled nursing facility. As explained below, these codes will be strongly correlated with the TCM codes in 2013.
2013 fee schedule’s post-discharge care codes could boost payments, shift workflow
11/12/2012
by: Ben Penn
Primary care providers stand to reap the most benefits from new CPT codes for transitional care management (TCM) following a discharge. The codes are featured prominently in the final 2013 Medicare physician fee schedule. Depending on the complexity of your medical decision-making (MDM) and the timeframe of a face-to-face visit, you will receive $121 or $170 for TCM services based on the non-facility rate and the new conversion factor of $25.0008.
 
Cardiology, ophthalmology, group practices suffer blow from newest MPPR cuts
11/12/2012
by: Lauren C. Williams
Cardiologists, ophthalmologists and group practices will see pay cuts for taking and reading imaging tests thanks to CMS’ latest expansions to the multiple procedure payment reduction (MPPR) in the final 2013 Medicare physician fee schedule. 
CMS gives more time to avoid payment cuts, adds 2 new e-Rx exemptions
11/12/2012
by: Karen Long and Laura Evans
You have more time to apply for e-prescribing exemptions to avoid the 1.5% cut to allowable fees for not participating in Medicare’s incentive program (e-Rx). In addition, the agency has added two new hardship exemptions in the final 2013 physician fee schedule to excuse providers from e-prescribing if they achieve meaningful use or plan to.
 
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