Be prepared to treat more Medicaid-eligible patients than you are used to treating. Many health plans are trying to increase their revenues by adding or expanding their Medicaid managed care product offerings. Private payers are eyeing Medicaid business now that the Patient Protection and Affordable Care Act (PPACA), the massive health reform law enacted March 2010, will swell the ranks of Medicaid-eligible patients.

A rise in place of service errors by your peers kept the improper payment rate in the double digits for the 2010 fiscal year that ended in September. The Comprehensive Error Rate Test (CERT) improper payment rate was 10.5% in 2010, nearly two percentage points lower than the 2009 rate, CMS says.

You won’t have much longer to wait for any annual wellness visits (AWVs) that were mistakenly denied to be repaid, CMS officials tell Part B News. Automatic reprocessing of affected claims is well underway at the affected Medicare Administrative Contractors (MACs).

Enrollment forms won’t be updated with the new advanced diagnostic imaging accreditation specialty designation until July, a CMS official confirmed with Part B News. This will leave imaging providers with less than six full months to update enrollment information before a Jan. 1, 2012 deadline.

This chart shows 10 high-denial codes that also saw some of the greatest utilization growth from 2008 to 2009. The analysis is aimed at tracking which specialties are responsible for the growth over the one-year period. NOTE: Codes billed fewer than 100,000 times in 2009 were excluded from analysis.

You will most likely face fewer medical record requests from recovery audit contractors (RACs) When you are chosen for a detailed RAC audit, thanks to a change CMS implemented on Feb. 14. A decision was made to modify RACs’ additional documentation limits “in response to feedback from the RACs, physicians and their associations,” CMS writes.

Your carrier can begin testing version 5010 of the HIPAA electronic transaction standard – used to securely send information such as Medicare claims – starting April 5, CMS says.

We are an internal medicine practice and bill ECG codes 93040 and 93000. I was advised by WPS that both codes are allowed and will be reimbursed. I add the modifier to 93040 (2nd) with a diagnosis of hypertension (401.9). Are these codes typically paid and is the modifier used correct?

At least four Medicare Administrative Contractors (MACs) are now reprocessing annual wellness visit (AWV) claims that were wrongfully denied in January, Part B News has learned. A slight majority of your peers report having had no problems billing the services so far; the rest are split between those who have gotten denials and those who haven’t yet billed the service.

You may have a successful appeal strategy for a repayment demand from your recovery audit contractor (RAC) only to have your carrier issue post-payment denials for the same claims for different reasons, such as missing signatures, Part B News has learned.