Download this month’s tool – the Primary Care Incentive Program Payment Calculator, created by Part B News – to help you determine whether your providers are eligible for PCIP money. If they are, the tool also helps you estimate how much incentive cash they can expect quarterly from Medicare.

We are a small rural doctor’s office and have patients coming to us for wound care management after surgeries taking place more than 100 miles away. These patients are being seen by our nursing staff and since they are not seeing the actual physician during these visits, we are not billing anything. The nurses do a nursing assessment, review of systems, medication and allergy review and the actual wound assessment, which includes wound measurements, tissue conditions and healing stage – a thorough wound assessment. We also do wound care education, along with medication review education. We would like to start billing these patients but are not sure how to do it appropriately. Any suggestions?

Brand new ICD-9 codes make up the bulk of the proposed changes to ICD-9, which primarily impact dermatologists, ophthalmologists, cardiologists, orthopedists and gastroenterologists, a Part B News analysis shows. The diagnosis of skin cancer, a toxic strain of E. coli, glaucoma, arterial embolisms and gastric band-related infections all would change starting Oct. 1, if CMS’s proposed ICD-9-CM updates go through.

Your peers seem to agree that the impending ICD-10 switch is monumental and deserves special attention, but rank it low on their list of competing priorities, according to a recent Part B News survey. Despite ICD-10’s distant implementation date in October 2013, it’s now time to start preparing for the switch, experts say.

Reassess the way you balance bill members of private payers when you’re an out-of-network provider. More states than ever are taking action to restrict or regulate the practice. Balance billing occurs when you charge a patient the difference between your provider’s usual charge and what the patient’s insurer paid you for the service. The use of balance billing by physicians has long been a subject of controversy.

You are not alone if you must ask your private insurance companies to authorize a diagnostic imaging test before you render it to your patient. There’s been an uptick in private payers screening cardiology and other imaging services before allowing them to be performed on the patient, some experts tell Part B News. But a quick chat with your patients’ carriers could get you paid faster and cut down unnecessary administrative legwork.

In addition to your payer being reluctant to allow imaging tests without proper authorization, there are some cases they will demand you perform imaging tests as a condition of pre-authorization for surgical treatment, adding to the confusion.

You face a hefty $505 per-provider fee as of March 25 when you enroll in Medicare as a supplier, even when you are revalidating an existing enrollment. Any physician or non-physician practitioner (NPP) practice that provides durable medical equipment (DME), prosthetics, orthotics and supplies to beneficiaries that are billed using DME codes and are paid on the DME fee schedule needs to be enrolled as a DME provider, and they will be affected by the $505 fee if they are newly enrolling as a DME provider or if they are revalidating their DME enrollment, experts say.

Electronic health records (EHRs) are still the exception rather than the norm at small and mid-sized physician practices across the country. For practices still on paper, the cost of buying an EHR remains the biggest barrier to entry, with nearly 72% citing the difficulty of getting startup cash as their biggest concern. This chart analyzes the payment methods used by practices that had EHRs as of 2010. NOTE: All data cited, including the above references to perceptions of barriers to entry, come from a recently released nationwide survey conducted by the Medical Group Management Association (MGMA). The MGMA survey received responses from more than 4,500 practices across the country.

Our office has started to perform and bill for the new Medicare Annual Wellness Visit (G0438) but we’re confused on what diagnosis code to report. Some in our office say it should be the problems we find during the visit, others say we should use diagnosis code V70.0 for a general preventive screening. What is the Medicare requirement?