Overall drug prices on the Part B Average Sales Price (ASP) list will tumble next quarter, CMS says. Prices will decrease by 0.7% despite a Part B News analysis of the ASP plus 6% payment system that shows a majority of the individual drugs will see price increases. The introduction of generics caused some drug prices to drop by 20% or more and brought down the rest of the list, CMS says.

Last week, Part B News detailed electronic health record (EHR) facts you must know before purchasing a system for your practice - setting you on a path toward earning $44,000 in federal incentives (PBN 6/21/10). You must also be aware of hidden or unexpected costs associated with these major purchases - which can send your EHR costs spiraling over budget.

You've got a second chance to participate in the 2010 Physician Quality Reporting Initiative (PQRI) and a second chance to earn a 2% bonus payment to boost your revenue. A new six-month PQRI reporting period begins on July 1, 2010. Even if you attempted PQRI during the first six months and gave up - you are still eligible to earn a bonus by reporting quality measures from July 1 through Dec. 31.

Last week, we told you about silent PPOs, a way that claims get latched onto your existing contractual agreements without your knowledge or, in most cases, your consent (PBN 6/21/10). Here are nine ways to protect yourself from actual or future silent PPO activity.

Summary: This chart compares the average value of services performed by specialties to their overall Medicare revenue based on 2008 CMS claims data, the latest available. NOTE: The dollar values reflect payments from Medicare only, and do not account for patient copays or deductibles. NOTE: Average payments per service were calculated by dividing total Medicare revenue by the number of successfully paid services. These 10 specialties were chosen because they had very high annual Medicare utilization in 2008, ranging from 37 million claims billed annually (urology) to nearly 344 million claims (hematology/oncology).

This week's question is answered by Regan Bode, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services.

Q.  Would you consider epidural injections moderate or high complexity medical decision-making? Would you consider RF or facet joint injections moderate or high complexity medical decision-making?

Medicare won't pay for an audiologist's services that are billed under a physician's National Provider Identifier (NPI) number, CMS clarifies in a transmittal to its payment policy manual. Historically, audiology services could be billed incident to a physician's services until Medicare changed its billing rules in 2008. CMS then required audiologists to have their own NPI (PBN 7/28/08). You may have been unclear with how to bill some patient scenarios you've encountered since then, but CMS is now clearing the air on its audiology billing policy.

The number of non-physician practitioners (NPPs) participating in Medicare has risen steadily over the last four years, growing at nearly four times the rate of physicians, an NPP Report analysis of CMS enrollment data shows. From 2006 to 2009, the number of nurse practitioners (NPs) and physician assistants (PAs) enrolled in Medicare increased by 7.5% and 7.2% respectively, compared to an average of 2.2% for physicians across all specialties.

This week's question is answered by Regan Bode, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services.  

Q: I have a radiologist who specializes in mammography and she is the director of breast imaging at a free standing facility in New Jersey. The company would like to offer genetic counseling when necessary. Licensure has been approved, but we don't have a license in place at the moment. Genetic counselors get NPI numbers. Is it possible to bill the service as an E/M under the radiologist, if she is present and has an order from the gynecologist for genetic counseling? Or does the genetic counselor bill 96040 under her name and NPI? 

Summary: This chart examines denials from a per-provider angle, looking at how the major non-physician practitioner (NPP) specialties fare when it comes to denials and the revenue they cost. NOTE: The number of denials is an average, calculated by dividing the number of denials into the number of providers enrolled in each specialty. The dollar cost of denials is also an average, derived from the average payment to each specialty, multiplied by the number of denials per provider. Denials are an average of denials for all codes billed in 2008.