You probably couldn’t be happier to have another year to implement the ICD-10 diagnosis code set, but that extra time may add unnecessary expense and slow efforts to transition to the new code set. “A lot of people are now thinking it really isn’t going to happen, when I know it is,” says Vicki Cadenhead, CPC, ACS-CA, who codes for 16 doctors in four practices at Texas Health Physicians Group in Dallas.

Providers risk not getting their prescriptions filled by local pharmacists unless they get a national provider identifier (NPI) by 2013, thanks to a provision in HHS’ final rule that delayed ICD-10 and established new payer identifiers for claims processing. But while there’s no direct penalty to providers, practices risk losing business relationships with their pharmacies because the provision affects Part D reimbursement, experts say.

Survive widespread audits of total joint replacement claims by bolstering documentation of each patient’s previously unsuccessful treatments that lead to the surgery, and make sure those notes are in the hospital’s records. One Medicare administrative contractor (MAC), TrailBlazer, denied almost 74% of a sample of claims worth $5.2 million for DRG 470 (Major joint replacement or reattachment of lower extremity without major complication/comorbidity) between July 2010 and March 2011.

Do a better job coordinating care and being accessible to patients, then pocket $20 per Medicare patient every month. That’s the deal that 500 primary care practices have signed on with as part of CMS’ Comprehensive Primary Care Initiative (CPC), a pilot program produced by the agency’s new Center for Innovation.

These charts show the number of annual wellness visit (AWV) codes billed per specialty in 2011, the first year CMS covered wellness visits. The utilizations of two AWV codes – G0438 (initial visit, $166.44) and G0439 (subsequent visit, $110.96) – are charted side by side for each specialty. All numbers come from a Part B News analysis of 2011 Medicare claims data.

Does CMS pay for 0276T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe) and 0277T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes)?

With all the changes in the healthcare industry, physician practices may need to reassess how they evaluate managed care contracts and reimbursement strategies, say some experts. What worked in past years may not be your best approach for the future.

The AHA and the AMA are at odds over two provisions in a final Medicare rule that give physicians more influence over hospital decisions. The final rule, which specifies how hospitals must meet the Medicare program's Conditions of Participation, requires the following: That a hospital or healthcare system cannot have a single integrated medical staff serving more than one hospital, but that each hospital must have its own medical staff, and that every hospital's governing board include a member of that hospital's medical staff.

Dual eligibles-patients eligible for both Medicare and Medicaid-could be a good target population for a physician practice if you are ready to accommodate them. Going after this pool of patients could be good strategy, but know what you're getting into.

The Supreme Court is expected to decide at the end of June whether the Patient Protection and Affordable Care Act (­PPACA) is constitutional, and whether the healthcare reform law should be overturned in full or in part, or remain intact. (The decision had still not been rendered at press time.) But regardless of the outcome, many physicians and healthcare executives emphasize that the current efforts to improve care coordination and quality and reduce costs should remain the focus of the healthcare industry going forward.