Medicare Physician Fee Schedule Fact Sheet

Need guidance on Medicare Physician Fee Schedules?

The Centers for Medicare and Medicaid Services (CMS) produced a short fact sheet on Medicare Physician Fee Schedules in December 2011.

Highlights of this fact sheet include:

• Pay rates for Physician Services 
• Pay rates for Therapy Services
• Medicare Physician Fee Schedule Payment Rates 
• The Medicare Physician Fee Schedule Payment Rates Formula (how to calculate payment rates for an individual service)
• Additional Web Resources on the Medicare Physician Fee Schedule

To download and view the complete fact sheet, please go to the following link: Medicare Physician Fee Schedule Fact Sheet

Proposed Medicare Physician Payment Act Will Repeal the SGR

The proposed bill: "Medicare Physician Payment Innovation Act of 2012" was introduced by U.S. Representatives Allyson Y. Schwartz (D-PA) and Joe Heck, D.O. (R-NV) on May 9, 2012. The proposed bill will repeal the Sustainable Growth Rate (SGR) as well as reform Medicare payments and delivery systems
Highlights of the bill include:

• Repeal the Sustainable Growth Rate (SGR) Permanently.
• Stabilize the current payment system
• Provide positive payment updates for all physicians.
• Institute interim measures to ensure access to care coordination and primary care services. 
• Aggressively test and evaluate new payment and delivery models. 
• Identify best practices and develop a menu of delivery model options.
• Provide alternative value-driver fee-for-service system 
• Establish a transition period.
• Reward clinicians for high-quality, high-value care while disincentivizing fragmented, volume-driven care.
• Ensure long term stability in the medicare physician payment system.

To download and view the full bill in detail, please go to the following link: Medicare Physician Payment Innovation Act of 2012

Ensure You're Billing Your Place of Service (POS) Codes Correctly

In medical coding and billing, place of service (POS) codes are two digit codes that specify where the patient received their treatment.  To ensure you are appropriately receiving payment, using the correct POS code is crucial.

According to the Centers for Medicare and Medicaid Services (CMS), incorrect billing of the POS code may result in over-payments to the physician and may also change the amount you are reimbursed by Medicare.

Billing the incorrect POS code may also cause your practice to face issues with the OIG (Office of Inspector General) as they have been reviewing correct POS coding in more detail over the past couple of years.

The following guideline, Place of Service Codes Guideline explains the POS codes and the descriptions for these codes as well as whether or not the pay rate is for a facility (F) or non-facility (NF).

To download and view the full guideline, please go to the following link: Place of Service Codes Guideline.

Evaluation & Management (E/M) Services - Proper Documentation

Proper documentation of your Evaluation and Management (E/M) Services is crucial when submitting claims to Medicare for your practice.

A short fact sheet was produced in April 2011 by the "Department of Health And Human Services - CMS" on proper E/M documentation. Topics addressed on this fact sheet include:

• Components of an Evaluation and Management (E/M) Service
• Tips on Documentation: ‘If It Wasn't Documented, It Wasn’t Done!’
• Determining the Correct Level of Code
• Links to Resources for: "1995 Documentation Guidelines for Evaluation and Management Services” and “1997 Documentation Guidelines for Evaluation and Management Services"

To download and view the full E/M documentation fact sheet published by the Department of Health And Human Services - Centers for Medicare & Medicaid Services, please go to the following link: Evaluation and Management (E/M) Services: Complying with Documentation Requirements

Modifier Billing Guide: Appropriately Bill Your Modifiers:

Modifiers used in medical billing and coding are the alpha or numeric character that coincides with the appropriate CPT code. 

If you do not use these modifiers appropriately, coding and billing errors will occur. Issues with fraud and compliance may also arise when you are billing and coding.

To be sure you are billing modifiers at the appropriate time, the below link will direct you to a Modifier billing guideline.

This guideline lists the modifiers by specialty and the appropriate time to bill the modifier with the specialty: Modifier Billing Guide

Third-Party Payers: Keeping Your Practice Up to Date & Optimizing Cash Flow

Enrollment with third-party payers is one of the most important pieces of your practice’s business foundation. 

If your enrollment or contractual information is outdated, you may not be collecting all the revenue available to you, your operations may be negatively impacted by delays in receiving payments. 
The incorrect information may also be reported to governmental entities in your name (i.e. the IRS) vs. the appropriate corporate entity.
You may be asking yourself the following questions regarding enrollment verification with third-party payers:

• How will you know that your practice information may be out of date?
• How do you ensure that the information about you and your practice are correct and how do you efficiently correct errors happen to you?

To answer these questions and more, follow the link below to download and view the guide:
Verifying Enrollment Data: A Step-by-Step Guide

Why Documentation is Critical in Medical Coding & Billing

Are you following the necessary steps to document your codes correctly?

• To ensure that you are coding and charging correctly, your documentation must be accurate.
• The coder must evaluate all of the physician's dictation and base their codes on that.
• If yourself or your physician does not document correctly, you may not be receiving appropriate reimbursement.

The following link will direct you to download and view a guideline where you can evaluate if you are following the necessary steps in order to document your codes correctly: ED E/M Documentation