Your practice may be left paying the tab for delinquent employees – past or present – who owe CMS money. The HHS Office of Inspector General (OIG) will target physicians who continue to receive CMS payments under a different national provider identifier (NPI) – including group IDs – after failing to pay back overpayments, according to the agency’s 2013 Work Plan.

A mistake as small as not having the nine-digit ZIP code on your enrollment form – required of physicians, non-physician practitioners and group practices – can lead to revocation of your Medicare payments. Enrollment expert Dennis Grindle has seen that happen, even though the problem is easily fixed.

Determine what you believe to be your own strengths and weaknesses and then assess what external opportunities and threats exist, which may impact your current strengths and weaknesses, favorably or unfavorably. Identify factors you believe are relevant in each of the four areas. We’ll give you examples below.

Depending on your vendor and how you have customized your functionality, physicians have access to different types of shortcuts when creating electronic E/M notes. Train staff to know which of these shortcuts your practice uses, the risks they present and how these risks will manifest themselves in the completed note.

These charts show the utilization rate of each initial patient E/M code (99201-99205) in 2009, 2010 and 2011, presented from left to right for each code. In this Part B Newsanalysis of the latest Medicare claims data available, utilization rate was derived by taking the total service count in a given year for each code and dividing it by the service count for all five initial patient office codes combined. For a look at 2009-2011 utilization for established patient E/M visits, check out PBN 10/8/12. 

Can you bill with modifier 59 (Distinct procedure) for a rotator cuff repair (29827) with the limited debridement (29822) of the labrum located in another area on the same shoulder? Or do you bundle the debridement with the procedure because it’s on the same side as the original operation? Or is it more appropriate to append modifier 59 to the debridement because it was performed on a separate area of the shoulder?

Smooth the transition to electronic health records (EHR) by developing an end-of-day closing process that ensures you’ll catch costly errors quickly before they damage your bottom line. Example: One physician had $25,000 outstanding from four months of unpaid hospital visit notes because he did not close out of the EHR screen after completing the documentation for each visit.

Avoid a reimbursement decline during the transition from being an independent practice to hospital- or health system-owned by training billing and coding staff. Those employees could have to learn a new electronic health records (EHR) system, provide more documentation for audits, get trained on hospital outpatient billing regulations and start reporting to a new office.

The complexity of peripheral vascular (PV) coding leads to high denial rates and risk of improper payments at cardiology practices. Here are four PV coding problems and solutions to ensure your claims are coded, billed and paid correctly:

Choosing a selective code when the documentation isn’t clear.