You must contact CMS if you want to know whether your hardship exemption to avoid the 1% e-Prescribing (e-Rx) payment penalty was granted, Part B News has learned. After you submit the exemption, CMS won’t give you a response either way; unless it needs additional documentation to make a decision, a CMS official tells Part B News.

Many practices have been switching banks as the economic slump drags on and some banks impose new and higher fees, combined with tighter standards for loans and lines of credit. But to switch to a new bank without disrupting cash flow, you must plan for a four to six-month process that involves having two accounts open and juggling payer paperwork, experts say.

You must be ready with advanced beneficiary notice of non-coverage (ABN) forms when facing services that Medicare will only cover with the right diagnosis code, and statutorily reject in all other situations. Here are five expert tips on how to recognize and prevent potentially non-covered services and avoid ABN overuse.

You and your peers earned more E/M revenue in 2010 than 2009, even though 2010 was the first year consult codes were eliminated. These charts show E/M revenue and utilization based on CMS claims data. For the top 10 E/M-billing specialties, 2010 was a year that saw positive E/M growth, with the exception of general surgery and ophthalmology.

These charts examine E/M code level selection for new and established visits (99201-99215) from 2009 to 2010, comparing primary care and specialists. Both primary care and the top E/M-billing specialists show a clear shift from lower-level E/Ms to higher level E/Ms. However, the shift for specialists is much sharper, driven by CMS eliminating consult code codes in 2010, which is a huge E/M change.

We have recently received a notification that CMS is going to do a “prepayment edit” of advanced imaging services because the Comprehensive Error Rate Testing program (CERT) data has identified a high error rate and that the X-ray orders must be signed by the treating physician. However, it is our understanding that X-ray studies do not need a signature and that the medical record alone could support ordering the test. Which is it?

You could get a revalidation letter in the next two months and thus be required to submit complete revalidations within 60 days of receipt – even if your providers have a record in the Provider Enrollment Chain Ownership System (PECOS), Part B News has learned.  Remember: CMS said in a Sept. 20 open door call that only providers not in PECOS would be served with revalidation letters before 2012.

You must take action now to avoid the 1% e-prescribing (e-Rx) payment penalty in 2012 – even if you already submitted a hardship exemption for implementing electronic health records (EHRs), CMS officials tell Part B News. Remember: The deadline to get an application submitted is Nov. 1, otherwise you’ll see the 1% pay hit start Jan. 1, 2012.

The 2012 Work Plan from HHS Office of Inspector General shows there is more than one way to review your incident-to and E/M service billing. Even though both issues have been targets in previous Work Plans, the type of errors the agency will look for are new.

You now have 168 brand new ICD-9 codes effective Oct. 1, plus dozens more CMS slipped in that were not in the proposed rule, according to a Part B News analysis of CMS’s finalized list of ICD-9 codes released in June. In addition to the 180 proposed changes issued in the May 5 proposed hospital inpatient prospective payment system rule, you will see 43 more new codes, 11 revised codes and nine invalidated codes.