Your hospital-affiliated practice will lose time and money next year on non-diagnostic services rendered three days prior to a hospital admission, according to the 2012 Medicare Physician Fee Schedule final rule. CMS finalized its proposal to lump Medicare Part B-billed services hospital-owned or operated entities render into a three-day payment window policy originally reserved only for hospitals.

If your practice is in the habit of “brown bagging” drugs for in-office administration, be aware that for fee-for-service Medicare, at least, this practice will be officially against the rules starting Jan. 1, 2012. Some physician practices write scripts and send the patient to an outside pharmacy to pick up expense injectable drugs and the practice bills for the injection.

Expect fewer headaches when it comes to taking on referred patients now that CMS finalized an enrollment form for non-Medicare ordering or referring physicians. The new CMS-855O form, proposed back in May and released Oct. 27, allows non-Medicare billing providers to refer patients to Medicare-enrolled participants without having to enroll in Medicare.

This chart examines a total of 20 modifiers, 10 of which had some of the highest denial rates in 2010 and 10 which had some of the lowest, comparing their 2010 rates with 2009. NOTE: Because 2010 was the first year in which CMS no longer accepted consult codes (99241-99255), the new modifier AI (principal physician of record). Thus, there is no 2009 data for this modifier, which is added to inpatient claims billed by the admitting physician. Adding modifier AI lets contractors know the services were furnished by the admitting physician who coordinates care, distinguishing them from services done by others who also see the patient.

CMS Administrator Donald Berwick, M.D., will officially resign his post effective Dec. 2, CMS says. News of the departure leaked Nov. 23 before CMS’s formal announcement. Berwick will be succeeded by Marilyn Tavenner, currently CMS’s principal deputy administrator, who has previously acted as administrator.

What is the correct way to code multiple trigger joint injections into the same site? Our physician gave patient 10 injections and we billed 20610 (arthrocentesis, aspiration and/or injection; major joint or bursa) times 10 units along with 1 unit of the medication and the claim was denied.

While healthcare organizations are exploring programs such as accountable care organizations (ACO) and medical homes, the efforts of two group practices already offer insights on how to make these programs work logistically and financially via a patient-centered environment and population health management.

Caught between healthcare reform mandates and a weak economy, many physicians are fretting that financial conditions will force them to postpone retirement indefinitely. It's no surprise that baby boomer and older "Silent Generation" physicians plan to delay their retirement. What is surprising is that Generation Xers are also thinking about it, even though retirement is many years away, according to Jackson & Coker, an Alpharetta, GA, physician placement firm.

Under healthcare reform, the payment structure will move from fee-for-service to a pay-for-outcome model, such as bundled payments, medical homes, or accountable care organizations (ACO). However, the change to a new payment model is going to be a bumpy and expensive one-and few organizations have the margins to lose reimbursement dollars during the transition period. With most providers having little margin to put toward a pilot program, and with an expectation of losing reimbursements once it's under way, a medical home is unappealing under the current payment system. However, there are pathways to making margin in the medical home.

Implementing an EMR requires planning and avoiding some common pitfalls, says Bruce Boissonnault, president of the Niagara Health Quality Coalition (NHQC), a nonprofit collaboration of business, healthcare, government, and consumer leaders in Williamsville, NY. Boissonnault also is the founding president of the Alliance for Quality Health Care (AQHC), a New York state col­laboration of leaders working to improve healthcare trans­parency nationally.