CMS is now going to cover one face-to-face visit each year for cardiovascular disease prevention. How should the new face-to-face visit be coded assuming that it’s separate from the annual wellness visit (AWV) and the health risk assessments (HRA)? Also, when does this take effect?

You face a 27.4% Medicare pay cut in three weeks, possible payment freezes from the HIPAA 5010 switch and the certainty of patients on high-deductible plans who are basically self-pay from a collections standpoint. Your best protection is a beefy line of credit, experts say.

You will see slight pay bumps for primary care services and some cuts to imaging specialty payments next year under the final 2012 final Medicare Physician Fee Schedule (PFS) thanks to CMS entering its third year of a four-year transition to a new dataset to calculate relative value units (RVUs) and not the five-year review, a Part B News analysis shows.

Nearly one in three practices don’t do a good job collecting copays at the time of service, making it less likely they’ll get every dollar they’ve earned. About 30% of your peers collect upfront less than 75% of the time, according to 2010 data from the Medical Group Management Association (MGMA).

Brace your practice for several weeks of contract negotiations – including a barrage of emails, phone calls and maybe an in-person meeting – once your payer is ready to talk money. The best way to get what you want is to be firm and persistent, experts say.

Part of a continuing series: This is part of an ongoing series about contract negotiations, which will help you prepare for and execute successful contract negotiations with your private payers. You can review all articles in the series via the searchable Part B News archives at www.partbnews.com under the “contract negotiations” search term.

These charts compare 10 codes with relatively low denial rates, yet were responsible for major dollar losses in 2010, to their denial rates and per-denial loss amount to 2009. NOTE: Codes with fewer than $1 million in annual Medicare payments were excluded from analysis, as were non-physician services (e.g. lab codes, supply codes). NOTE: The dollar losses per denial were calculated by dividing the annual paid amount by the total services less the number of denied services. They reflect national average data and do not account for patient-responsible amounts; only the allowable amounts actually paid by Medicare. The fees listed along the bottom for each code are based on the current 2011 fee schedule.

If you simultaneously perform an anterior cervical fusion and corpectomies, is it correct to report 22551 (neck spine fusion and decompression) and 63081 (removal of vertebral body) or would it be 22554 (neck spine fusion) and 63081? Also, if you use a microscope can you add modifier 59 and 69990 (microsurgical techniques, requiring microscope, list separately in addition to primary procedure code) to the 63081 claim?

You and your peers now have an extra 90 days to test claims and get your practice ready for the HIPAA 5010 claims transaction standard thanks to CMS pushing the enforcement date back to March 2012, CMS announced on Nov. 17. Don’t breathe easy just yet. You’re still on the hook to comply by Jan. 1, 2012.

Expect Congress to stop the 27.4% cut to your Medicare physician payments before 2012, and replace it with two years of 0% updates. You face even more uncertainty for 2013, thanks to a new wrinkle introduced in the law passed to raise the U.S. debt ceiling in August. That law resulted in Congress creating a Super Committee that was supposed to deliver a plan for $1.2 trillion in deficit reduction over 10 years.

You’ll still get paper faxes, paper lab results, paper mail and patients waving paper forms after adopting an electronic health record (EHR) system – slowing you down and limiting your EHR’s effectiveness. The best solution is to use a combination of scanning paper documents, having physicians convert the most important data to EHR, and to work with paper-based practices to develop a better way, experts say.