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Physician fee schedule: Payment modifier applies only to large groups in 2015

11/12/2012

The value-based payment modifier won’t kick in until 2017 unless your practice employs 100 or more providers, CMS states in the final 2013 Medicare physician fee schedule. The modifier will adjust all physicians’ payments depending on how they improve care and reduce costs compared with others in their region and specialty.

2013 fee schedule brings new rules for CRNAs, DME, drugs, outpatient therapy

11/12/2012

by: DecisionHealth editorial staff

Here’s a round-up of other items from the final 2013 Medicare physician fee schedule, released Nov. 1, that affect your practice. (Note: Part B News has provided the page numbers and a link so you can read that piece of the rule at http://pbn.decisionhealth.com/Resources/GetFile.ashx?FileId=100775.)

Benchmark of the Week: Part B News' 5-year payment analysis

11/12/2012

by: Lauren C. Williams

Track your payment changes for imaging services and office visits from 2009 through 2012 and your prospective payments for next year based on relative value unit (RVU) changes listed in the final 2013 Medicare physician fee schedule.

Final 2013 fee schedule released: Physicians paid to coordinate care

11/05/2012

by: Part B News staff

Primary care physicians will get a 7% pay increase and other providers will see bumps between 3% and 5% in 2013, according to the final 2013 Medicare physician fee schedule released late Thursday. The 26.5% sustainable growth rate (SGR) cut that would offset those increases on Jan. 1 will likely be delayed again, CMS said in a statement.

5 tips to train coders and billers during transition to new practice ownership

11/05/2012

by: Ben Penn

Base the training your coding and billing staff will need on the structure of new practice ownership to avoid workflow and billing disruptions during the transition. Once you’ve asked the hospital or health system acquiring your practice key questions to gauge the anticipated learning curve, delve deeper and consider how much training your staff will need and how it will be provided.

MGMA: Stable pay key to drive tech investment, shared-savings participation

11/05/2012

by: Scott Kraft

Lack of stability in the physician payment structure – particularly from Medicare – is having big impacts on investment in technology as well as participation in the shared-savings programs the government believes are critical to reducing health care costs, according to a survey released by the Medical Group Management Association (MGMA) at its annual conference in San Antonio last month.

Brush up on modifier 25 knowledge before a private payer audit

11/05/2012

by: Ben Penn

Don’t consider work you did to determine medical necessity for a minor procedure a separately identifiable E/M service. In those cases, using modifier 25 (Separately identifiable E/M service) will result in denials or recoupments. Anthem Blue Cross has sent warning letters to California providers who bill E/M codes with modifier 25 “significantly more often than other physicians within the same specialty.”

Streamline front-desk tasks to improve HIPAA compliance, patient flow

11/05/2012

by: Lauren C. WIlliams

Your front desk is a hub of activity and distractions that can leave your practice vulnerable to HIPAA violations, such as failing to disperse the notice of privacy practices or not obtaining signed HIPAA release forms. Avoid those problems by designing a streamlined system to obtain the necessary HIPAA-related forms from patients.

Identify all existing conditions when coding for patients with angina pectoris

11/05/2012

by: Kevin McDermott

Your physicians risk pay loss on claims treating angina and other related coronary artery disease (CAD) conditions if some and not all of a patient’s existing conditions are listed on the superbill. Your physicians risk pay loss on claims treating angina and other related coronary artery disease (CAD) conditions if some and not all of a patient’s existing conditions are listed on the superbill.

CMS updates enrollment rules for out-of-state practice locations

11/05/2012

by: Ben Penn

The paperwork burden of enrolling a new out-of-state practice location into Medicare is now reduced thanks to an Oct. 19 CMS transmittal. The enrollment changes, effective Nov. 20, clarify that you don’t need to fill out a separate 855A, B or I form for a new out-of-state location, so long as you meet a list of criteria.

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