Start with CMS's guidance for IV hydration therapy (96360, $56.62) when you audit your claims. That's what your Recovery Audit Contractor (RAC) will use to determine whether you've received an overpayment for this service. The rule: "The hydration codes are used to report a hydration IV infusion which consists of a pre-packaged fluid and /or electrolytes (e.g., normal saline, D5-1/2 normal saline +30 mg EqKC1/liter) but are not used to report infusion of drugs or other substances."

Sure, you're eligible to receive incentive payments in 2010 for e-prescribing work you did in 2009 (PBN 12/8/08). But the HHS Office of Inspector General (OIG) sees a high chance of fraud or abuse, so it has put your practice on its radar to be sure you rightfully earned the money. Review of e-prescribing payments will help the OIG prepare for reviews of the even larger incentive payments that will be handed out in the future for implementing electronic medical records system (EMR), OIG writes in its just-released 2010 Work Plan.

You and your peers are billing more high-level established patient office visits than ever before, a shift upward from low and mid-level E/M codes, an exclusive Part B News analysis shows (see chart). The facts: 99214 (office/outpatient visit, est., $92.33) made up 30.9% of all claims submitted with codes in the 99211-99215 series in 2008 - dramatically up from 20.7% in 2000. 99214's increased share represents a numerical increase of 34.2 million claims submitted over the eight year window.

You'll need to start using two new enrollment forms by Nov. 30 or risk your application being denied by your carrier. CMS made mostly minor edits to the forms, but make sure you download and use the correct forms before you begin the time-consuming enrollment process. The changes apply to CMS-855I (for physicians and non-physicians) and CMS-855B (for medical groups and clinics).

You increase your revenue and keep your billing team sharp by resubmitting denied claims, but most practices don't think about five important factors, experts say. Take these into account to maximize your chances of getting every last dollar you're owed.

it’s more effective to deal with disruptive behavior proactively—before it starts—but that’s difficult if your practice doesn’t have a code of conduct in place.

Eliminate the guesswork in determining the place of service (POS) when your physician provides a consult service (99241-99245) in a hospital emergency room by looking at the patient's status, experts say. The correct POS is not going to be the same POS every time.

Once you’ve determined employees’ specific roles, you should go over their responsibilities and what is expected of them. This is ideally done at the beginning of the year.

You'll need to attach one of three new modifiers when filing claims for a "never event" surgery. You still won't get paid for never event claims because of medical necessity (PBN 6/22/09). But the modifier you use sends a signal to your carrier to place the patient and the date of service for the surgical error on a list, CMS says.

Generation X is no longer a newcomer to the healthcare industry—the oldest are in their 40s and in the middle of their careers—and the schism between physicians has grown larger and more damaging. Whether they like it or not, the time is rapidly approaching for boomers to hand off healthcare leadership to their successors.