Payers have various rating, tiering, and ranking systems that attempt to assess a physician’s performance against his or her peers. Some of these systems may be tied to reimbursement rates, but mostly they are used to steer patients
to physicians in the higher-quality tier.

Mistakes and inefficiencies can be reduced if a healthcare organization implements “Lean,” a business approach that considers customer value to be paramount, he says. Under this principle, any time or resources invested in anything else become wasteful.

You've always captured patients' names and contact information, but the more information you can get, the more likely you are to boost patient satisfaction - and collect more of what you're owed. You'll want a thorough list of the information you need, and spend the most effort on the items you deem most important. First of a two-part series.

A new addition to a series of claim adjustment reason codes (CARCs) will save you the time and trouble of writing a letter or calling your carrier for clarification. Next April, you'll start to see certain CARCs with the phrase "Note: Refer to the 835 Healthcare Policy Identification Segment, if present" on electronic remittance advices (see chart in full story). The language means you will be able to see a number in the healthcare policy identification segment that you can then use to find the policy on the payer's website once the new 5010 standard is implemented for HIPAA-compliant electronic transfers of claims data.

This week's question is answered by John Burns, CPC, senior consultant for DecisionHealth Professional Services.

Q.  One of our NPs currently provides consults for other providers in our practice. Now that Medicare is cutting consults, how will she bill these patients: New or established?

Great news: Your non-physician practitioners (NPPs) will most likely see payment increases across the board in the next four years, assuming Congress stops the 21.2% pay cut (PBN 11/12/09). This chart shows how payments for 10 services commonly billed by NPPs (at least 1.5 million claims annually) will look over the next four years, starting with current data and using the current conversion factor (CF) to calculate the payments.

Your bread-and-butter audiology codes are at the edge of a payment cliff - and they'll be pushed off starting Jan. 1, 2010, thanks to changes in the final 2010 Medicare Physician Fee Schedule (PFS).

CMS significantly increased the proposed payment for kidney disease education services to patients with stage IV chronic kidney disease (CKD) starting Jan. 1. You'll report either kidney disease education codes G0420 for an individual session or G0421 for a group session. G0420 and G0421 will pay about $108 and $25.60, respectively.

Q. What sort of documentation do we need to support the use of modifier 22 (unusual procedure)? We're not sure how much more work it takes to make the procedure unusual.

Good news if you bill Medicare for Avastin for off-label treatment of age-related macular degeneration (AMD): The massive price cut that went into effect Oct. 1 is no more.