How do you bill diagnostic services that fall under consolidated billing? Do you bill Medicare Part B for the professional component and Part A for the technical component, or do you identify Part A patients and only bill Part B using modifier 26(professional component)? Also, is it fraudulent for a skilled nursing facility (SNF) to have providers bill Part B global and when the technical component is denied, reimburse the SNF once we provide them with the remittance advice?

Your doctors may get a break from hospital rounds, thanks to a CMS rule that grants non-physician practitioners (NPPs) the same hospital privileges. The hospital and critical access hospital reform final rule, released May 9, counts NPPs such as advanced practice registered nurses (APRNs) and physician assistants (PAs) as part of medical staff giving them the power to use their licensed skills in hospitals.

A recent report from the HHS Office of the Inspector General (OIG) showing a rise in higher-level E/M coding selection over the past decade includes nurse physician practitioners (NPPs) among the possibly suspicious physicians who consistently bill a level 4 or level 5.

This chart shows the breakdown of specialties among the nearly 1,700 physicians who billed either a level 4 or level 5 for at least 95% of all their E/M codes in 2010. The 1,700 consistently high-billing doctors were chronicled in an HHS Office of the Inspector General (OIG) report released this month.

You have less than two months until your private payers and CMS stop accepting non-compliant HIPAA 5010 claims. Maintain cash flow and prove your practice is 5010-ready by the June 30 enforcement deadline with documented communication from your payers and clearinghouses.

Rather than wait for ICD-10 to make documentation enhancements vital for the new code set, start those changes now to improve your practice’s private payer reimbursements.

Private payer contracts are changing to reflect the severity of your patients in two key ways:

Auditors love to go after E/M services for a few reasons. First, as you probably know, payers spend the most on these services and they are billed in huge volumes, making it easy to establish patterns. Since code selection is so subjective, E/M services are an easy target to recoup because it’s harder for you to prove your code selection.

Find opportunities to increase your practice’s efficiency through a consistently monitored benchmark dashboard that allows you to compare your performance against your specialty. The metrics you include in a benchmark dashboard will vary based on specialty and your personal preferences, but it’s vital that you have accurate in-house numbers to see where you have room for improvement, says David Zetter of Zetter Healthcare Management Consultants in Mechanicsburg, Pa.

Primary care Medicaid reimbursements stand to receive a significant boost from a CMS proposed rule that would match in 2013 and 2014 the Medicare physician fee schedule rates for Medicaid patients. The federal government would be required to foot the bill on whatever the difference is between the Medicare rate and each state’s Medicaid rate.