These charts show the latest trends in inpatient versus outpatient services billed to Medicare per specialty, comparing 2010 ratios with 2006. All percentages come from a Part B News analysis of the latest Medicare claims data available. Inpatient services are defined as those that were billed with place of service (POS) codes 21 (inpatient hospital) or 23 (emergency room) and outpatient services were billed with POS codes 11 (office) or 22 (outpatient hospital). Note: The percentage figures refer to the share of all utilization for each specialty in a given POS. For example, cardiologists in 2010 billed 24.7% of Medicare services using POS codes 21 and 23 and 75.3% with POS codes 11 and 22.

Don’t rush the non-physician practitioner (NPP) hiring process if you want to see the intended workflow efficiencies and financial results. Thorough research of state laws and NPP credentials, complete physician buy-in and clearly delegated tasks are all necessary before you bring on these new providers.

Instruct non-physician practitioners (NPPs) to justify orders for portable X-ray services with written statements about the patient’s need to avoid denials and survive audits. CMS has proposed to expand its policy on who can order mobile X-ray services from just physicians to include podiatrists, dentists and NPPs, according to the proposed 2013 Medicare physician fee schedule.

This chart presents the denial rates of all E/M office visits appended with modifier 25 (separately identifiable E/M service), organized by both place of service (POS) code and non-physician practitioner (NPP) specialty. Data represent all 99201-99215 codes appended with modifier 25 that were billed to Medicare in 2010, the latest year available.

It’s our understanding that Medicare does not cover audiology tests without a physician’s order. But what if the patient wanted the test anyway? Would it be appropriate to bill with modifier GY (service provided is statutorily excluded from the Medicare program)? Will appending the modifier defer payment responsibility to the patient?

Don’t lose money following CMS’ time-based E/M coding rules for private-pay patients. CPT policy, which most private payers follow, allows you to round to the nearest time interval and that could mean rounding up. Any denials should be easily appealable, so long as your math is correct, you maintain accurate time estimates and you’re only using time to select the code when greater than 50% of the visit was spent counseling the patient, coding experts say.

Don’t write off retail health clinics as the natural enemy. Instead, explore opportunities to cultivate partnerships with the increasingly popular clinics if you’re looking to add new patients. Non-physician practitioners (NPPs) employed at CVS MinuteClinics, which account for nearly half the nation’s retail clinics, ask patients whether they have a permanent primary care physician. If the answer is no, the NPP will give the patient a list of nearby primary care practices currently accepting new patients, according to a company spokesperson.

Respond to questions asked through patient portals within 24 hours to increase participation and the likelihood you’ll receive incentives for proposed stage 2 meaningful use measures. About 98% of patients who ask questions through York (Neb.) Medical Clinic’s patient portal receive answers on the same day, says Practice Administrator John Tritt. Timely responses are one way the 10-provider family medicine practice boosted portal participation to 1,500 patients.

Keep your practice from hemorrhaging thousands of dollars after a breach of protected health information (PHI) by encrypting your office’s most used devices – computers, copy and fax machines – for little to no money, experts say. Encryption, which is an electronic way of disguising information that is sent to or stored on a computer, can save your practice the time and expense that breaches have cost other providers.

Practices lost nearly $22 million in 2010 for denied post-operative care claims billed with modifier 55(post-operative management only) – mostly because of a lack of coordination with emergency room and out-of-town providers. The fact that a patient has to receive care from another provider out of state, poor communication between the out-of-town and local providers as well as rapid claims billing contribute to an overall 18% denial rate for Medicare claims with modifier 55 in 2010, experts say.