See if you can make any sense out of what is below.  Don’t feel bad if you can’t.  Neither can the physicians who must comply with this stuff.  This regulatory maze, combined with notoriously low rates of pay from Medicare, combined with the severe penalties for non-compliance (jail time) serve together to achieve the rationing of care the government thinks will help balance their books.  

Price controls and regulations typically proliferate within failed and bankrupt government programs.  Endless tweaking rules the day rather than an admission that the program was ill-conceived to start with and should be scrapped.  To allow the free market to work is, after all, an admission of the failure of the “state.”  

I think that more and more Medicare beneficiaries will appreciate that rather than render the medical care the bureaucrats demand from their physicians, the physicians are increasingly walking away from these controls and forging new and mutually beneficial arrangements with their individual patients, free from the Medicare Stasi.  

G. Keith Smith, M.D.

Good Morning,

If you get a denial from your MAC or a request for a refund from a RAC auditor, you might think that appealing is futile. But more than half of the redeterminations that MACs processed from Part B providers last year were actually decided in the practice’s favor, making your odds pretty good for a positive outcome. Out of 2.1 million redeterminations decided in 2012, 51 percent were either fully or partially favorable to the Part B practices who filed them, according to a recent OIG audit of first-round Medicare appeals for Parts A and Part B between 2008 and 2012.

In addition to this, you need to stay in –tune with MPFS Updates 2014, policy changes, such as ‘incident-to’ billing and multiple procedures, additions in quality reporting, know what’s new for physicians and non-physician practitioners and understand how provider-based clinics being affected.
This has become all the more important, as proposed 2014 Medicare Physician Fee Schedule, the conversion factor for 2014 is estimated to be $26.7109, which reflects a 21 percent cut from the current conversion factor of $34.0320. Additionally, you may have heard inklings of other Part B practices undergoing HIPAA audits, but because the scope of the audits was so small, you didn’t prepare one for yourself! It’s all about to change from Oct. 1, 2013 as OCR will start auditing medical practices for HIPAA compliance any day now, you can’t afford to fall short on your compliance. Also, you’ve got ICD-10 implementation to think about.

Moreover you may be anticipating the new CPT changes in the coming year and effective January 1, 2014, you have distinct areas of CPT® changes affecting your practice’s reimbursement. Here’s a sneak peek at some of the CPT® 2014 changes coming your way: 

  • New codes for ERCP: stent placements, removals, insertion of drainage tubes, and ablation
  • CPT® 2014 adds new code 52356 that experts say will have a significant impact on urology practices.
  • Eight new codes for endovascular aneurysm repair
  • Prepare to add more chemodenervation code choices in 2014
  • Greet the massive digestive system coding overhaul with more than 80 code additions, revisions, and deletions in the 40000 level codes.
  • 14 new codes for placement of breast localization devices.

 So the big question is – are you ready for all the upcoming changes? 

Subscribe to our weekly newsletter (45 issues) – Part B Insider – to give your practice the much-needed multi-specialty Part B edge and stay profitable and compliant.

Here’s a sample of what we’ve covered in recent issues of Part B Insider:

  • Know about New gynecology codes and CPT® updates, deletes, and revises surgical offerings
  • Prepare to add more chemodenervation code choices in 2014. Know the new codes and their descriptors
  • Clarify vascular stent and embolization coding as CPT 2014 replaces six codes with nine new options
  • 5 RAC findings that could be troubling for your practice. Know what are they and how you can correct these issues.
  • Get the lowdown on HITECH revisions to your HIPAA notice of privacy practices.
  • CERT Report: Get a lowdown on which specialties are billing improperly, and where your specialty stands.
  • Know what’s included in the global surgical package, and what you can report separately.
  • Avoid billing CPAP with E/M. Know why.
  • Failure to differentiate co-surgery from assistant surgery could cost you thousands.
  • Learn how will retrograde treatment change coding for carotid artery stenting?
  • 37241-37244 codes require you to know the type of vessel being embolized and why.
  • Learn how to report new codes for esophagoscopy performed with a rigid scope using an oral route and using a flexible scope via nasal route.
  • Tips will help you to rewrite your endoscopic coding as you’ll have to watch for scope type and route used for entry in 2014.
  • Insights on RAC activities, approved RAC audit issues, operational challenges under the RACs, and developing issues that you should consider in their compliance and auditing activities.
  • Otolaryngology: One code change could net you extra pay in 2014. Know this
  • Coding tips for new codes polyneuropathy and dysphagia in 2014.
  • How you should update your policies and NPP – how do you document them, to whom do new copes go, and how?
  • Medicare documentation guidelines for New Patients vs Established Patients.
  • Brush up on overpayment policies now that CMS has 5 years to request refunds.
  • EHR myths that could be setting you up for payer audits
  • Know when it’s appropriate to toggle between two different sets of E/M guidelines for the same chart
  • Find out what is included in critical care time and how you should bill for it.
  • Collect — and keep — your annual wellness visit and transitional care management pay with these essential tips.
  • Learn when they can — and can’t — report 99291-+99292.

Please use the link below to purchase:


Please apply discount code “SAVE50” at checkout to get an additional $50 discount on purchase. (Note: This discount coupon is valid till October 17, 2013 only).

 Looking forward to have you onboard with us.

Matt Kent