Can a provider dictate a discharge summary the day before the patient is discharged from a hospital or facility and receive credit for it?

CMS is weighing several options and seeking comments on how to construct, verify and submit documentation for its proposed face-to-face requirement for durable medical equipment (DME) orders (see related story). Review the graph below to see CMS’ different scenarios. CMS does not plan on adopting every option listed and wants your input on the proposed policies and any alternatives. Comment on CMS’ proposals at www.regulations.govby Sept. 4 under CMS-1590-P.

Non-physician practitioners (NPPs) are included in a major component of the proposed 2013 Medicare physician fee schedule that would create a new G-code for primary care practices to receive additional payment for post-discharge transitional care management.

This G-code, which would pay a work RVU of 1.28 on top of the E/M office visit, would cover non-face-to-face services provided by community physicians and NPPs in the 30 days following a facility discharge.

A provision in the proposed 2013 physician fee schedule would end denials of pain management services provided by certified registered nurse anesthetists (CRNAs), but don’t assume this portion of the rule is a done deal. Anesthesia practices should take advantage of the comment period to submit their support for this portion of the rule.

Prepare to document non-face-to-face time and to create a new workflow template to justify an extra $104 for recently discharged patients that CMS proposes in its 2013 physician fee schedule. While it’s too soon to begin building workflow changes specifically for CMS’ proposed G-code for post-discharge transitional care management, you can determine the amount of additional energy you would need to expend to realize the up to 7% payment increase for primary care practices (PBN 7/16/12).

Be ready to spend time collecting and calculating payroll information to share with your accountant if you want to take advantage of the Affordable Care Act’s small business health care tax credit, which could save you thousands of dollars.

The tax credit is meant for small companies to offset the cost of providing employee health insurance, according to www.healthcare.gov.

A brief explanation of the surgeon’s need for an assistant could secure reimbursement and dodge denials for assistant surgery, which are on the rise. Modifier 80 (Assistant surgeon) was the top denied modifier in 2010, based on a Part B News analysis of Medicare claims (PBN 5/7/12). The denial rates rose to 20.9% in 2010 from 18.9% in 2009.

Expect minor pay increases and decreases overall this quarter for your most frequently billed drug codes with an average 2% raise. CMS leveled out its adjustments for 2012’s third quarter average sales price (ASP) list, effective July 1, by giving pay bumps to about 40% the listed drug codes.

Be prepared to bill patients directly for an even greater share of your claims. Patients who will pay for their care because they haven’t hit the deductibles of high-deductible health plans (HDHPs) are shifting how practices go after collections. Practices used to “pound on” insurance companies for payments. “Now it’s the patient. You need more savvy staff at the front desk,” explains Doral Davis-Jacobsen, manager of health care consulting, Dixon Hughes Goodman, Asheville, N.C.

These charts present payer performance based on two key determinants – amount of time it takes to send first payment and the percentage of claim lines paid $0 for any reason. Payer timeliness is broken down by time ranges of zero to 15 days, 16 to 30 days and 31 to 45 days. For the second chart, the claim lines were paid $0 for such reasons as denials, claim edits and patient responsibility.