RAC Court Ruling Deals Blow to CMS

A US Court of Appeals ruling earlier this month that invalidates a provision of Medicare's 2014 Recovery Audit Program contracts is the latest setback for federal officials who administer the…

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States Taking Initiative on Dual Eligible Cost Containment

In an effort to control healthcare costs of the nation's oldest, poorest and often sickest patients, 34 states have implemented or are planning integration programs within the next two years…

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Why Must CMS Overreach on Rules?

Joseph Goedert Health Data Management Blogs, September 2, 2011 To prove meaningful use of electronic health records, providers must collect, organize and report data culled from certified electronic health records…

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Benefits of Medicaid EHR incentive program

Meaningful use expert Jim Tate has written that the Medicaid EHR incentive program reminds him of "zero entry" swimming pools: very easy to get into, with almost no barriers. Given…

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Put Your ePrescribing Knowhow Into Meaningful Use

Get your system moving before June 30th or you’ll pay the price.

If you do not have an electronic prescribing (ePrescribing or eScribing) system yet in place, or have not integrated one into your electronic medical record (EMR) system, you better get a move on it. You only have until June 30, 2011 to submit at least ten claims to Medicare demonstrating that you are a successful eScriber for 2011. Otherwise, you are at risk of not only losing the bonus in 2011 but according to the rulemaking for 2011, also facing penalties assessed, reducing your Medicare fee schedule by 1 percent in 2012.

With limited time, it is smart to consider a stand-alone internet based system which you can implement relatively easy. You could get this system up and running right away, at a low cost, with simplified a implementation timeline and without depending on your electronic health record (EHR) selection and implementation which is both much more extensive, costly and more complicated to implement.

If you’re still asking, “Can our practice afford not to adopt ePrescribing?” Then, the answer is NO. Today you need to start doing something.

Background: eScribing is part of Centers for Medicare and Medicaid Services’ (CMS) incentive program called the Physician Quality Reporting System (PQRS). PQRS offers incentives to practices that meet CMS-set goals for the implementation and practice of electronic prescription on a regular basis. The system was designed with “a carrot and a stick”. While we have been enjoying the “carrot” for the past few years, the “stick is on the cusp of being implemented as of June 30th per the 2011 Rulemaking. CMS will pay you when you implement eScribing in 2011 (a 1 percent bonus), it will penalize you when you don’t put it into practice, a 1percent penalty...

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Remember Diagnosis to Support 62311 Post-Op

Question: Our state’s Medicaid carrier denies our claims when we submit 62311 with modifier 59 for postoperative pain management. They say the 62311 is bundled with the anesthesia procedure code. How should we handle this?  -Ohio Subscriber Answer: ...

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Know When to Append Modifier 50 on Bilateral CTS Shots

Your orthopedist injects both of a patient’s wrists to treat carpal tunnel syndrome. Should you just file 20526 with modifier 50 appended and forget about it? Not so fast: If the physician injects both the patient’s wrists to treat CTS, you will ty...

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52300 or No 52300 For Ureterocele?

Question: My urologist performed a cystoscopy, transurethral incision of an orthotopic ureterocele, ureteroscopy, and a double J stent placement. I have drawn a blank on how to report the ureterocele incision. Here is the doctor’s note: “A 24 resec...

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Registration open for electronic health records incentives

On Jan. 3, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) opened the registration for the Medicare and Medicaid electronic health record (EHR) incentive programs. It was started in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas and broad participation is invited from eligible professionals and eligible hospitals who wish to participate.

In February, the registration will open in California, Missouri, and North Dakota and in other states during the spring and summer of 2011.

“With the start of registration, these landmark programs get underway, and patients, providers, and the nation can begin to enjoy the benefits of widespread adoption of electronic health records,” CMS Administrator Donald Berwick, MD was quoted as saying in the news release. “CMS has many resources available to help providers register and participate, and we look forward to working with eligible professionals and eligible hospitals to facilitate the process, beginning on January 3rd and going forward.”

“It’s time to get connected,” said David Blumenthal, MD, MPP, National Coordinator for Health Information Technology. “ONC and CMS have worked together over many months to prepare for the startup on January 3rd. ONC’s Certified HIT Product List includes more than 130 certified EHR systems or modules and is updated frequently. ONC also has hands-on assistance available across the country through 62 Regional Extension Centers. We look forward to continuing to work with CMS to assist eligible providers in 2011 and future years.”

The news release said that interested providers can acquaint themselves with the programs’ requirements by visiting CMS’ Official Web Site for the Medicare and Medicaid EHR Incentive Programs.

Eligible providers seeking to participate in the Medicaid programs must initiate registration at CMS’...

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Payer Update: UHC Sticks With Consult Codes

Check with Medicaid plans, insurer warns. You can breathe a sigh of relief — one major payer will stick with 99241-99255. UnitedHealthcare (UHC) commercial plans will make no change in payment for consultation codes (99241-99255) at this time, according to a UHC e-mail alert. “Physicians may continue to submit claims for these services, and will be reimbursed according to United-Healthcare payment policies”. Beware: One Medicaid [...] Related articles:

  1. Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report...
  2. Payer Update: NGS Directives Vs. Proper Skin Lesion CodingIgnore the LCD and stick with what you know about...
  3. Pssssssst. Payer Report Cards Are OutIf you know your payers’ strengths and weaknesses, you’re better...

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