This chart compares current stage 1 meaningful use requirements to the very early, stage 2 meaningful use requirements, which were released Jan. 28. The stage 2 requirements are a draft, released as a request for information (RFI) by the HHS Office of the National Coordinator for Health Information Technology (ONC).

These charts examine trends in utilization and denial for laboratory services paid by Medicare from 2008 to 2009. The percent values above the bars refer to the change in denial rates and utilization, respectively, from 2008 to 2009. Denial rates have fallen for most of these high-use services, but they remain extremely high for blood glucose test 82948 and fecal occult blood test 82270, which were billed more than 500,000 and 1.3 million times respectively in 2009.

An opportunity to be paid for MRIs done on patients with implanted defibrillators, plus CMS posts a sample form for private payers to use when considering premium increases of 10% or greater.

What are the documentation guidelines for when a physician admits a patient to observation status and then the next day the same patient is admitted and seen as an inpatient?  Would the physician have to dictate a separate report for the physician’s chart (in office) for this or can the physician just note this on the progress note at the hospital?

You and most of of your peers probably haven’t been able to fully comply with the first stage of meaningful use requirements needed to earn your share of federal incentive dollars, but the government is already planning to make the next phase tougher.

Your Medicare Administrative Contractor (MAC) and other Medicare auditors are free to review claims history for data mining and during complex review to determine whether payment for a claim is appropriate, CMS says in transmittal 367 to its Program Integrity Manual.

You must take your documentation to the next level to avoid being snared by carriers who use tougher medical necessity standards on one of the most common service types: established E/M visits. Extremely high error rates – averaging 51% and 91% – were found for codes 99211-99215 by one carrier during its most recent medical review.
 

You and your peers must double down on documentation for prothrombin time or risk getting costly denials thanks to a marked growth in post-payment reviews that challenge prothrombin time billing. At least three Medicare Administrative Contractors (MACs) have posted Comprehensive Error Rate Testing (CERT) findings that show a clear focus on services with physician orders, including prothrombin time.
 

Expect payments for three ECG monitoring codes and a heart catheter insertion and placement code to change slightly due to fee schedule changes your Medicare Administrative Contractor (MAC) needs to implement by April 4, according to CMS transmittal 2167 to its Claims Processing Manual.