With physician practices threatened by declines in reimbursement and increased regulation, it is critical for office staff to streamline work flow and optimize revenue performance, says Teri Gatchel, MBA, CPC, Southwest regional director for AAPC Physician Services in Salt Lake City.

Don’t be surprised to deal with more private payers when treating Medicare beneficiaries, even when your patients are insured under traditional fee-for-service Medicare. Many managed care plans are expanding into the booming senior business by entering the lucrative Medicare supplement insurance market.

As Medicare reimbursements decrease and many smaller group practices struggle to maintain their margins, more than a few physicians have begun to seek the financial shelter afforded them by hospital employment. Not all physician practices, however, are interested in giving up their independence to join their local hospital or health system, and in some rural settings physicians aren't interested in a long-term commitment to the area. Clinical comanagement agreements offer physicians and hospitals an opportunity to thrive, but their structure may vary, especially as accountable care organizations (ACO) take seed.

You must educate patients before and during annual wellness visits (AWVs) in order to boost their satisfaction and your chances of getting copays for E/Ms billed alongside AWVs, practice sources say. It’s common for enough separate physician work to occur in an AWV appointment that a significant, separate E/M service is billable, says Norma Keim, practice administrator at Cranberry Medical Clinic, a solo primary care practice in Terra Alta, W. Va. Remember: You attach modifier 25 (significant, separate E/M, same physician/day) to the E/M when billing it with the AWV.

A study published in the May 2011 online issue of Archives of Internal Medicine has created a field-tested "top five" list of potentially unnecessary cost drivers for primary care that-if reined in-could improve cost and efficiency.

Codes with modifier 59 (distinct procedural service) attached represent a major source of lost non-E/M revenue. This chart shows denial rates for high-utilization codes with modifier 59 attached in 2009 and compares them to their rates from 2005. NOTE: Codes with low utilization and/or low value (as measured by annual reimbursement paid out by Medicare) were excluded from analysis.

Being a medical director is nice work if you can get it. A physician medical director can add several thousand or even hundreds of thousands of dollars to his or her ­compensation package for duties that can range from recruitment, ­attending meetings, conducting clinical peer reviews, and strategic development.

Hospital-affiliated physician practices could see drastically smaller reimbursements for non-diagnostic services rendered to patients who are subsequently admitted to the hospital, according to the 2012 proposed Physician Fee Schedule (PFS). Physicians in practices wholly owned or operated by a hospital be paid at the facility rate, instead of the non-facility rate at which they are currently paid, if their patient is admitted to the hospital within three days of visiting the physician for an issue related to the reason for admission.

If you want to be on your best footing for contract negotiations, understanding your practice and your needs is not enough. You also need to understand the overall healthcare market and how current conditions will affect your negotiations, says Kyle Kobb, a principal at Equation, a healthcare consulting firm based in Salt Lake City.

Time is quickly running out for Congress to raise the $14.3 trillion debt limit by Aug. 2 and keep the U.S. from defaulting on its loans and threatening the billions of dollars in funding of government programs. But despite the tug-of-war taking place on Capitol Hill, there seems to be no details on if or how Medicare would be affected should the U.S. default, experts say.