These charts show the utilization rate of each established patient E/M code (99211-99215) in 2011, 2010 and 2009. In this Part B News analysis 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 established patient office codes combined.

Can we bill for both a bladder scan (51798) and complicated catheterization (51703)? Our Medicare administrative contractor, Wellmark, says the catheterization is included in the allowance of the bladder scan. But its Improve the Claims Adjudication Process (ICAP) edits policy contradicts that while CMS’ policy does not allow for a complicated catheterization in conjunction with a bladder scan performed in an office setting on the same day. Were they right to deny our claim?

A recently posted recovery auditor (RAC) issue targeting E/M codes, especially established patient office visit code 99215, raises the risk that practices will have to pay back a percentage of all of those claims for the past three years.

CMS approved the audit Sept. 12 for Region C RAC Connolly’s 15 southern states.

Physicians opposed to healthcare reform may feel like they’re caught in a scenario out of Back to the Future. All that hope and hype over lawsuits against healthcare reform for the past two years has gotten physicians squarely back to 2010, when it all started. With the U.S. ­Supreme Court generally reaffirming the Patient Protection and Affordable Care Act (PPACA), docs are trying to decipher their own diagnosis for what’s ahead.

Don’t let poor documentation of hospital-based cardiology services put you in the crosshairs of a hospital audit and force you to pay back thousands of dollars in improper payments. Secure revenue by justifying medical necessity for all diagnostic tests and procedures performed and by keeping up with hospital records.

Physicians added their voices in July to the intractable task of finding an informed solution to the Sustainable Growth Rate. Sen. Max Baucus (D-Mont.), chair of the Senate Finance Committee, hosted physician group representatives as part of a series of roundtables on Medicare payments. Previous roundtables featured former administrators of CMS and private payers.

Expect to close the year with minor pay changes overall for your most frequently billed drug codes. CMS leveled out its adjustments for 2012’s fourth quarter average sales price (ASP) list, effective Oct. 1, by giving pay bumps to about 40% of the listed drug codes. Drug prices for the fourth quarter averaged a 1.7% pay cut but remain relatively stable in comparison with previous quarters, CMS says in its ASP report.

On occasion, medicine resembles the game of golf, and not just because some doctors like to hit the course on Wednesdays. For instance, the secret of a successful patient-centered medical home (PCMH) may boil down to this: a lot of hard work and a few technology tricks.

Physician practices are currently operating in a transition period, with many trying to answer key questions about their futures while being plagued by financial and regulatory uncertainty. What happens when the tougher questions come up as we move toward implementation of health reform in 2014, which is likely to mean more patients in the system and a push for you to work with hospitals, integrated health systems and other provider types?

In implementing the Patient Protection and ­Affordable Care Act (PPACA), there’s at least one provision that ­Congress possibly felt it couldn’t afford—or simply didn’t care enough about—to fully fund. The healthcare reform law, which was upheld by the Supreme Court on June 28, called for the establishment of coaching programs for physicians. Yet without much federal money, this program has flourished anyway at state and grassroots levels.