Don’t be surprised to have to meet Medicare and Medicaid’s meaningful use requirements even when you deal with private payers. But it’s only adding to the confusion – more of them are adopting the federal government’s meaningful use criteria as a part of their own quality incentive programs – but in addition to, not in replacement of, other pay-for-performance criteria.

Overall losses from denials per practice continues to rise. Seven of the 10 specialty types listed below suffered more denial dollars per provider in 2010 than they did in 2009. However, one of the three groups that improved, medical specialties, did see one of the most dramatic year-over-year differences out of the 10 groups, with a 20% decline from 2009 to 2010. NOTE: The cost of denials per provider is an average, calculated by dividing the total amount of denials paid per specialty by the number of providers enrolled in each specialty. NOTE: The data labels at the top of each set of bars below signify the difference in denial amount per provider from 2009 to 2010.

Our physicians provide annual wellness visits (AWV) and bill either 99397 (periodic comprehensive preventive medicine re-E/M of an established patient) or E/M visits, 99212-99215, in addition to the AWV especially if the patient has a current issue or needs follow up on a chronic disease. The providers distinguish between the annual physical (99397) and a preventive exam, such as the AWV, as separately billable. Is this correct? Also, can you bill for an annual physical (99397) and an AWV if the patient’s secondary insurance covers the 99397?

Don’t assume the New Year’s onslaught of high deductible patients has to mean unavoidable headaches and cash flow problems. Instead, tackle quarter one with a pragmatic strategy that is considerate to patients’ financial situations to secure more payment from more high-deductible patients.

With the whirlwind of changes regarding the industry switch to HIPAA 5010, you must make sure your practice can comply quickly with as few hiccups as possible. Keep pushing to get your practice into 5010 compliance despite CMS holding your claims for 10 days and HHS’ 90-day enforcement delay ending March 31, experts say. 

Hospitals may be the driving force in the bundled payments pilot program – recruiting you and your peers as prospective partners – but the responsibility falls on you to do your research and prepare to be wooed. In order to maximize the potential benefits of cost savings and improved patient satisfaction from the bundled payments initiative, do your due diligence during negotiations with the hospitals recruiting you. 

One of your biggest challenges after switching to an electronic health records (EHR) system is translating everyday paper-based routines to an EHR-compatible process. Save your practice time and money with advanced planning to head-off problems that hamper workflow, experts say.

Stack your appeal letters with claim-specific clinical data and input from your physicians for the best shot at collecting on denied claims. Treat your appeals process as if you were presenting your case in court, by showing the payer all the evidence in your favor upfront, says Joan Gilhooly, CPC, president of Medical Business Resources in Lorain, Ohio. 

While most practices said it was too soon to tell, of those willing to make an observation, the majority say fewer patients have been able to pay deductibles in 2012 than last year, based on 288 responses to a Part B News subscriber survey taken between Jan. 5 and Jan. 9. Practices strategize to collect unpaid deductibles mostly by sending billing letters or statements (88%) and offering a patient payment plan (79%), according to the survey.

Will Medicare reimburse E/M codes for new patients,99201-99205,or established patients, 99211-99215, along with 96372(therapeutic, prophylactic, or diagnostic injection) on the same day or must modifier 25(separate, significant E/M, same physician/day) be attached?