Who picks more high-level E/M codes, nurse practitioners (NPs) or physician assistants (PAs)? These charts examine the ratio of new and established patient E/M levels by NPs and Pas, comparing 2009 data to recently released 2010 data. NOTE: Incident-to services billed by non-physician practitioners (NPPs) appear as additional physician utilization in CMS claims data, thus the NPP services in this data do not include those that were billed incident-to.

According to Medicare guidelines for split-share billing, the non-physician practitioner (NPP) and physician must conduct distinct parts of the service. In which scenario is this most appropriate and how do you bill it?

You could be letting money walk right out the door if you don’t offer your patients enough ways to pay their bills. Practices now generate about a third of their revenue directly from the patient compared to 3% to 4% several years ago, says Rick Altinger, a vice president for Intuit Health. You always want to collect patient balances at the time of service, but offering patients multiple payment options boosts collection efforts.

You and your peers have steadily billed more observation services to Medicare and fewer inpatient care codes as requirements for inpatient status have tightened – but denial rates remain stubbornly high. With the creation of new subsequent observation codes in 2011 and CMS publishing different rules for their use than CPT, providers have more reasons than ever to be confused, experts say.

Your incident-to and E/M service billing will be subject to further scrutiny going forward as the HHS Office of Inspector General (OIG) will be looking for new errors in those areas and others as part of its just-released 2012 Work Plan (PBN 10/10/11). Several E/M services will continue to be targeted in the 2012 work plan, including the new addition of use of modifiers during the global surgery period.

You have just over two months left to upgrade to and successfully send test claims through HIPAA version 5010 software. Testing a claim in 5010 with your clearinghouse or payer can take days or weeks before you get a response and there are a lot of new requirements that could trip providers up and cause their test claims and potentially live claims to be denied, experts say (PBN 9/12/11).

Expect either a letter or an email from your Medicare Administrative Contractor (MAC) warning you that you face a 1% payment penalty in 2012 under the e-prescribing (e-Rx) rule. CMS will send a separate letter or email to practices that submitted an e-Rx hardship exemption to avoid the penalty, that informs them whether their request was approved or denied.

These charts compare how primary care providers perform against specialists when it comes to denial rates on common surgery services. For each of these codes, primary care is responsible for a significant share of utilization, despite the fact that specialists still bill the majority to Medicare. NOTE: “Primary care” reflects combined data from family practice, general practice, internal medicine, geriatrics and OB/GYN. The “specialists” category represents combined data for more than 20 other specialties, excluding only those with low Medicare utilization (e.g., plastic surgeons). NOTE: The percentages above the bars reflect averagedenial rates.

At what point after an initial event is a condition considered “a manifestation of a late effect of the condition,” such as a stroke? Is it six months?