Nine-hour work days in a closet-sized office are standard issue for Susan Gateau, CMC, practice manager at Cambridge Pediatrics in Waldorf, Md. But 12-hour days that make the already cramped walls feel like they’re closing in on her have dominated this week, the practice’s first week using its new electronic health record (EHR) system. “It’s been rough,” Gateau admits. “We’ve all been on edge, and there’ve been a lot of glitches in the system.”

CMS has just handed out the first wave of incentive payments – worth $75 million – to physicians such as yours across the country who have adopted electronic health records (EHRs) and met meaningful use under the Medicare EHR Incentive Program. Two of these successful doctors have tips and experience to share with you, in exclusive interviews with Part B News.

Managing denied claims effectively is necessary to keep your practice afloat. But you could be losing money that you are entitled to by not aggressively pursuing claims denials, experts tell Part B News. It’s easy to get inundated with other tasks and end up being buried in denied claims you think you don’t have time to sift through and appeal, says David Zetter, a consultant with Zetter Health Care in Mechanicsburg, Pa. But your financial losses can pile up quickly when if you are not diligent about reviewing and appealing denials when necessary, he warns.

Expect things to go wrong when you implement an electronic health record (EHR) system, according to your peers who have gone through the process. When they do, you need to know who to go to for timely assistance, especially once your providers have begun exclusively using the EHR to see patients. This chart lists actual problems and issues encountered by Cambridge Pediatrics as well as the organizations they contacted for help.

Using the wrong modifier, having a missing modifier or even adding an unneeded one are all big reasons for denials and cash being left on the table. This chart takes a look at denial rates for the most commonly used modifiers based on the latest CMS claims data from 2008 and 2009.

Can we bill the new initial wellness code G0438 in addition to the traditional code G0101 for the pelvic/breast exam if we are acting as the primary care provider for the patient. Will Medicare reimburse both of these during the same encounter?

Dianna Abney, MD, is a human whirlwind most days at Cambridge Pediatrics, a seven-provider pediatric practice in the sleepy commuter town of Waldorf, Md. Most days, she spends upwards of 10 hours juggling babies, parents and progress notes, rarely standing still – an all-out, cyclonic approach that she intends to apply to the biggest professional change in her 19-year career: switching from paper to an electronic health record (EHR) system. 

You don’t have to prepare for and implement electronic health record (EHR) systems alone, as the example of Cambridge Pediatrics clearly shows. This chart shows how Cambridge secured help from four outside organizations, which ultimately all receive federal funding in one way or another, to help practices adopt EHRs and achieve meaningful use.

You and your peers may get four more options to avoid the 1% e-Prescribing (e-Rx) Medicare payment penalty if you qualify for one of CMS’s new proposed hardship exemptions outlined in its May 26 proposed rule. The proposed rule would give providers a more flexible timeline and more options to claim a hardship exemption for not being able to meet the e-Rx requirement by June 30.

You could be seeing less claim denials caused by referrals from providers who aren’t enrolled in Medicare – or interested in enrolling – thanks to a proposed new type of enrollment application, CMS announced May 20 in the Federal Register. The new enrollment form, called the CMS-855O, would enable providers who are not enrolled in Medicare and have no plans to enroll or bill to go through a streamlined enrollment process solely to generate an identification number.