This chart ranks the difficulty of the remaining 12 proposed meaningful use requirements. There are 25 requirements; the first 13 were ranked in the first round of this feature (PBN 1/18/10). Rankings and analyses are subjective, based on in-depth interviews with Robert Tennant, senior policy advisor for the Medical Group Management Association's (MGMA) Washington office, Carolyn Hartley, president of Physicians EHR, a Cary, N.C. company that helps practices adopt electronic health record (EHR) systems and Scott Decker, CEO of NextGen Healthcare Information Systems, an EHR vendor headquartered in Philadelphia. 

Summary: Denials for 10 of the most common surgery codes billed to Medicare have fallen almost across the board from 2007 to 2008, reversing a trend of slight increases in denial rates from 2006 to 2007. NOTE: The codes were selected based on utilization figures and associated specialty, including ambulatory surgery centers (ASCs), to ensure that a variety of surgical procedures were represented. The bold numbers above the bar graphs indicate the change in denial percentages over the one-year period. NOTE: The dollar amounts for each code below are based on the 2010 Medicare Physician Fee Schedule.

This week's question is answered by Margie Scalley Vaught, CPC, coding content specialist for DecisionHealth.

Q. Is it possible for us to bill G0250 for the interpretation of a patient's home test results?

Nurse practitioner (NP) groups are protesting an AMA report that warns lawmakers and state officials about NPP scope-of-practice limits and clinical qualifications for services often performed by physicians, NPP Report has learned.

Be sure to use the ICD-9 code 585.4 (chronic kidney disease, stage IV, severe) on claims billing the new stage IV chronic kidney disease (CKD) education services G0420-G0421 (NPP Report 11/23/09). Your claims will be denied without this diagnosis code. 

Summary: The two major non-physician practitioner (NPP) specialties, nurse practitioners (NPs) and physician assistants (PAs) have been billing more common imaging services over the last four years. NOTE: The percentage figures above the bars indicate the net year-to-year change. Because 2004 is outside the timeframe analyzed, 2005 has no data.

This month's question is answered by Margie Scalley Vaught, CPC, coding content specialist for DecisionHealth.  

Q. How do we document and bill the following scenario: The PA or NP examines a patient while on the phone with the doctor (who is at home) during a patient exam. The doctor agrees with the NPP's findings. Can we bill this as a telehealth service?

Guidance from carriers detailing how to bill what used to be lower-level inpatient consults in 2009 has started trickling out. The problem: The previous codes (99251-99255) don't match the inpatient hospital care codes (99221-99223) you're supposed to bill (PBN 12/21/09). Specifically, there is not a good match in the inpatient initial visit code series for the two lowest-level inpatient consult codes, 99251 and 99252.

You've seen how demanding some of the proposed meaningful use rules are (see breakdown chart) and how little time there is to demonstrate meaningful use and earn your share of the incentive pie. Now the good news: The proposed meaningful use rule is so strict that there's almost no chance for the final rule to be more difficult. The final rule will either maintain the same requirements or water them down, experts tell Part B News.

If you want the electronic health record (EHR) stimulus money  - as much as $44,000 in extra Medicare payments or $63,750 in Medicaid bonus payments per physician - you have to demonstrate "meaningful use" of certified electronic health records (see story).