Many practices have seen revenues fall as a result of private payer patients not meeting their copay and deductible obligations. But perfecting your practice’s collection techniques is the only way to plug the revenue leak, experts tell Part B News. An increase in premiums, plus employers adjusting their health plans to include higher deductibles have shifted greater financial responsibility to patients, experts say.

Your claims with modifiers 58 (staged, related service, post op, same physician) or 78 (return to or for related procedure, post op, same physician) attached have a higher rate of being denied, according to a Part B News analysis of CMS claims data. Experts say the onus is on you to ensure proper usage of modifiers.

This table gives a snapshot of three different "free" electronic health records (EHR) system vendors, breaking down the EHR's features, noting any associated fees and a quick profile of the EHR's user base (PBN 8/15/11). 

You must be ready to use the right modifier when billing many common services in the same encounter as the new annual wellness visit (AWV), according to an exclusive Part B News analysis of the latest version of the National Correct Coding Initiative (CCI) edits. The initial AWV code, G0438 (initial wellness visit, $161.05), is now subject to more than 100 edits in CCI version 17.2, which went into effect July 1.

Twice as many E/M codes are billed in the outpatient setting than inpatient, but the average denial rate is higher in the outpatient setting. This chart compares the E/M codes on a level-by-level basis in the two settings to examine where the denials are happening. NOTE: The “outpatient” setting is a combination of CMS claims data for place of service (POS) codes 11 (office) and 22 (outpatient hospital), while the “inpatient” setting is a combination of POS codes 21 (inpatient hospital) and 23 (emergency room).

CMS took questions from your peers on the new advanced diagnostic imaging requirement, the Primary Care Incentive Payment (PCIP) program and the agency’s ongoing efforts to reprocess claims, but the answers don’t offer fast solutions. Here’s the rundown on the top issues CMS addressed during its latest Aug. 9 open door call for physicians and non-physician practitioners.

Can primary care physicians (MDs) be paid by Medicare for CPT codes for health and behaviorial assessment services (96150-96152)? If not, are there any HCPCS codes they could use?

You have 13 months to purchase, implement and optimize an electronic health record (EHR) system, reach meaningful use and report it to CMS. The cut-off date to begin meaningful use attestation and earn the first $18,000 incentive payment is Oct. 1, 2012. That’s a date that most of your peers don’t plan to miss, a Part B News reader survey found (see survey results here).