CMS and the Office of the National Coordinator for Health Information Technology (ONC) are hard at work on creating the official proposed rule for stage 2 meaningful use. What you can expect is found in the very first draft, the request for information (RFI) version of stage 2 measures.

CMS has changed the global days on simple repair codes (12001-12018) from 10 to 000 effective 1/1/11. Was it CMS’s intention to start allowing payment for post-op visits related to providing these procedures, such as providers now billing a low-level E/M involving suture removal?

For the past two years, Southeast Texas Medical Associates (SETMA) has been on a journey to be recognized as a patient-centered medical home (PCMH)—although, in truth, the journey began more than a decade ago. 

When you’re scrambling for revenue anywhere you can find it, terminating a managed care contract may sound like the last thing you should do. But in fact, getting rid of a contract that is not working for you can actually make your practice more profitable.

In one of my favorite sections of David McCullough’s biography of John Adams, the author relates a vivid scene of Adams and Benjamin Franklin about to share a room in Newark, NJ, and not being very happy about the prospect. They argued over whether to keep the window open. Adams, saddled with a head cold, didn’t want any part of the chilly night air, whereas Franklin enthusiastically sought out the fresh air. In the end, Franklin won; the window was left open through the night.

With about 10% of claims denied on average, a physician practice must have a specific plan in place to respond to denials. Otherwise, you are forfeiting a significant amount of revenue that is rightly yours, says Brian Sanderson, JD, a partner with Crowe Horwath, LLP, in Oakbrook, IL.

You may be able to use registered nurses (RNs), licensed professional nurses (LPNs) or other licensed medical professionals unable to enroll in Medicare to perform the newly covered annual wellness visit (AWV) in its entirety under direct physician supervision and bill the service under the physician’s national provider identifier (NPI).

You will need to take the paper records for more than 50% of your patients and convert them to electronic records in your electronic health record (EHR) system, as well as ensure that 40% of your prescription are transmitted electronically in order to get your $18,000 bonus payment under the EHR Incentive Program.

Big changes are coming in 2012 to the way CMS pays Medicare Advantage (MA) plans, which in turn will impact the number of MA patients you see and how much you’ll be paid for seeing them. On average, MA plans will see a 1.6% reimbursement increase in 2012, but this figure will vary based on your region

Expect the reprocessing of claims impacted by passage of the Patient Protection and Affordable Care Act (PPACA) to begin in approximately two weeks, CMS officials announced during a recent conference call. But before you start a daily watch for these funds, note that the agency expects it to take months to re-run the hundreds of millions of claims impacted.