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Tool of the Month: How to compare your allowables

09/26/2011

Download this month's tool -- a spreadsheet showing how to set up utilization data and compare your allowables.

Use this tool to help calculate how much money you’re being paid by each payer and plan, for each of your top 25 codes, using the payers’ different allowables and your own utilization data to see whether one or more of your payers is paying much lower than others and your contract needs to be renegotiated.

NPP Report: NPs, CNMs can earn $21K in Medicaid EHR cash in 2012 without meeting meaningful use

09/26/2011

by: Grant Huang

Your nurse practitioners (NPs) and certified nurse midwives (CNMs) stand to collect $21,250 each under the Medicaid electronic health record (EHR) incentive program, a little-known fact because no non-physician practitioner (NPP) of any kind can participate in the Medicare EHR program, which pays out $18,000 in the first year. NOTE: Physician assistants working in a federally qualified health center or rural health clinic are also eligible for the Medicaid incentive.

NPP Report: Bill your PAs like doctors for surgery assists

09/26/2011

by: Lauren C. Williams

You and your peers have lost over $171 million in denied claims with modifier AS (assistant in surgery) attached, according to a Part B News analysis of CMS’s 2010 claims data. The best way your practice can stave off such losses is to be discretionary when using non-physician practitioners (NPPs) in surgery assists.

NPP Benchmark: Top high-growth, high-denial NPP services, 2009-2010

09/26/2011

by: Grant Huang

These charts show 10 of the fastest-growing codes billed by non-physician practitioners (NPPs) that still have high denial rates; all based on the newest 2010 CMS claims data. NOTE: Lab codes, supply codes, codes that generated less than $1 million in annual reimbursement and codes with low denial rates were excluded from analysis. NOTE: All utilization and denial rates below reflect combined CMS claims data for audiologists, certified nurse midwives, certified registered nurse anesthetists, chiropractors, nurse practitioners, physician assistants and physical therapists.

Ask an NPP Report Expert

09/26/2011

Can a nurse practitioner see new Medicare patients? If so, where does CMS specify this?

Get review of systems right to get level 3 and level 4 E/M codes paid

09/19/2011

by: Grant Huang

You and your peers bill level 3 and level 4 E/Ms to Medicare more than any other service, but confusion over whether which of these levels is right causes many physicians to defer to a 3, which won’t reduce audit risks but will reduce revenue, experts say. Use these three strategies to improve physician documentation so you keep more of the revenue earned from the two most common E/M services.

The fine print behind recording patient vitals, demographics and smoking status

09/19/2011

by: Grant Huang

You won’t have a hard time recording patients’ vitals, demographics and smoking status, but you may not have to in some cases. The key is to incorporate the collection of these data points seamlessly into your workflow, experts say. While practices that have met meaningful use say these measures were easier to achieve than other core measures, you must be aware of these less well-known facts about them.

Two major CMS clarifications on subsequent observation codes

09/19/2011

by: Laura Evans

You can’t add prolonged services on top of the new subsequent observation codes (99224-99226), and you now have explicit rules from CMS on whether the admitting or consulting physician should bill subsequent observation. CMS has clearly taken a position against CPT, which means you may have to code differently for Medicare patients and privately insured patients who get the same services in the same situation.

You could be recruited to partner in bundled payments initiative

09/19/2011

by: Lauren C. Williams

Your practice could be approached by your local hospital to enroll in CMS’s new bundled payment pilot program. You may also be recruited by a “convener” – an organized group of practices who want to participate, experts tell Part B News. The bundled payments initiative is essentially a step down from an accountable care organization (ACO) but more flexible, says Neil Kirschner, senior associate of regulatory affairs for the American College of Physicians (ACP).

5010 transaction standard will require physical billing address

09/19/2011

by: Marla Durben Hirsch

When you submit claims electronically, check to see if you’re using a post office box or lock box on your claim forms. If you are, you need to change the information in your billing provider address field in order to comply with HIPAA and get paid on time. Version 5010 requires you to use a physical street address in the billing provider address field, not a P.O. or lock box.

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