Codes recommended by CMS for RUC review

You now face restrictions on separate billing of facet joint injections and telehealth visits alongside a wide array of surgery codes, according to a Part B News analysis of the latest version of the Correct Coding Initiative (CCI) edits, which took effect July 1. There are 16,928 changes, almost all of which are new edit pairs. For comparison, that's eight times the number of changes in the previous CCI version, which had just 2,195 changes (PBN 3/29/10).

Congress finally passed a Medicare payment patch to delay the devastating 21.3% cut to your reimbursements for six months and replace it with a 2.2% increase retroactive to June 1. CMS has yet to announce how it will reprocess your June claims paid at a reduced rate, but the HHS Office of Inspector General (OIG) says you will not need to collect any additional amounts from patients who received care from you between June 1 and June 25, which is the date the pay fix was signed into law.

Your claims will not be automatically rejected on July 6 when they contain orders or referrals from providers not properly enrolled in CMS's Provider Enrollment, Chain and Ownership System (PECOS), the agency announced June 30.

The proposed 2011 Medicare Physician Fee Schedule (PFS) is pulling double-duty, packed with expansions of existing CMS initiatives plus major Medicare changes mandated by the health reform law. The law's emphasis on preventive medicine is taking the form of major benefits for primary care, starting with a new, routine service billable once a year for all beneficiaries, free of copays and deductibles, plus new coverage for more than 30 preventive services.

Does your physician practice have what it takes to be lean?

For decades now, we’ve heard about manufacturers and retailers running Lean or Six Sigma or whatever you want to call it—putting workplace processes from scheduling to supplies management under the scalpel to carve away excess overhead, inefficiencies, and redundancies.

This summer, the American College of Physicians (ACP), which represents 130,000 internists, will publish a series  of papers that will tell America’s doctors what they should and should not order in diagnostic tests and therapies, a guideline that strives to lower cost while eliminating unnecessary care.

The number of physician-owned medical practices is declining. In 2005, two-thirds of all medical practices were doctor-owned, but the number is now below 50%, according to the Medical Group Management Association. More physicians are looking to sell their practice in favor of being employed by a larger medical group or hospital. Some are tired of managing the business, whereas others are concerned about the impact of healthcare reform on their practice. 

In the past, many physicians considered their medical staff leadership responsibilities a privilege and thus did not demand compensation. However, in recent years, it has become common practice for hospitals and medical staffs to compensate chiefs of staff and medical staff presidents, committee chairs, and department chairs for their leadership involvement.

Before joint replacement patients set foot in an operating room at the Agnesian Center for Bone and Joint Health, they start in a multidisciplinary presurgical education session. A nurse answers questions about the surgical process, a pharmacist talks about anticoagulation and pain medication, a rehab representative explores home modifications and other postsurgery issues, and a discharge planner lays the groundwork for the postsurgery transition. By surgery time, not only does the patient have a better idea of what to expect from the process, but so do the providers.