Your practice is violating CMS policy if your providers don’t handle their own enrollment and re-enrollment.

But CMS is aware that the practice of sharing a physician’s username and password to update his or her information in the Provider Enrollment Chain and Ownership System (PECOS) is happening, said Zabeen Chong, CMS’ information technology and services director, at DecisionHealth’s 2012 National Medicare Provider Enrollment Summit on Oct. 5.

Doctors among those charged in nationwide fraud sweep. The Medicare Fraud Strike Force rounded up 91 people – including doctors, nurses and other health care professionals – in connection with schemes across the country that totaled $429.2 million in false billing, according to a Justice Department press release.

This chart shows the annual wellness visit (AWV) denial rates for the 13 specialties that billed AWVs most frequently in 2011, the first year Medicare allowed practices to bill wellness visits. For each specialty, the overall denial rate is on the left; on the right is the denial rate for AWVs appended with modifier 25 (Separately identifiable E/M service). Note: This data, derived from a Part B News analysis of Medicare claims data, combine the overall service counts and denied service counts of the two AWV codes, G0438 (initial visit) and G0439 (subsequent visit).

Can we bill Medicare for both the professional fee and ambulatory surgery center (ASC) facility fee if the physician performs an abdominal paracentesis in the ASC?

A CMS recovery auditor (RAC) has requested records with E/M code 99215 from three providers. It’s the first step in a process that appears headed toward CMS’ widespread approval of an extrapolated audit in 15 states next year and potentially the entire nation. Region C RAC Connolly’s findings from 90 records submitted by those three providers will determine whether CMS grants widespread approval of the audit in the entire jurisdiction.

Expect even more scrutiny of your Part B payments next year from HHS’ Office of Inspector General (OIG). The agency’s 2013 Work Plan, published Oct. 2, details several new audit issues for ophthalmology services and drug reimbursements.

Analyze your surrounding market and patient demand to determine whether expanding your hours to evenings and weekends could lead to more patients and not lost revenue. As more retail health clinics and urgent care centers open, your patients will be less likely to accept the traditional 8 a.m. to 5 p.m., Monday through Friday schedule.

You now have until April 1, 2013, before you have to worry about CMS’ place-of-service (POS) policy, which was slated to take effect Oct. 1.
The delay came as part of a new transmittal published Sept. 28. “This is an update to transmittal 2435, which clarifies how place of service should be coded,” said Christina Ritter, CMS’ director of practitioner services on a Sept. 28 open-door call.

You may be able to recoup some of the expense of offering a patient portal and even earn some revenue from it by charging for online consults or portal access. Portals could make it easier to meet stage 2 meaningful use requirements that at least 5% of patients have access to health information online and message securely with providers.

Practices are split about whether paper forms or the Provider Enrollment Chain and Ownership System (PECOS), CMS’ online enrollment tool, better suits their needs, according to attendees at DecisionHealth’s National Medicare Provider Enrollment Summit 2012. Wellspan Health System uses paper enrollment forms because of the time it takes to collect physician information.