Exclusive: ACR Convergence 2024| Focus Rheums

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Billing/Coding

2011 CMS e-Prescribing Program: Will You Get Hit with Penalties?

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The Medicare Improvements for Patients and Providers Act of 2008 provides for e-prescribing financial incentives in 2011 and financial penalties in 2012 and 2013. When you successfully e-prescribe and report on 25 patient encounters, you will be eligible to receive a 1% incentive of the total estimated allowed charges for professional services covered by Medicare Part B rendered in 2011. The big news, however, is the payment reductions for those who do not successfully meet e-prescribing reporting requirements that will be applied—1% in 2012 and 1.5% in 2013.

RHEUMATOLOGY PRACTICE PEARLS: Is Your Practice Ready for 5010?

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If your practice electronically submits administrative transactions to verify patient insurance eligibility, file claims, or send or receive remittance either directly to insurance companies or through a clearinghouse, the transaction version for that system will have to be updated by January 1, 2012. The current version 4010 is outdated and cannot accommodate the necessary business transactions for physician practices and healthcare facilities.

PRACTICE PAGE: The ACR Takes on Insurance Companies

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In response to the increasing demands of medical necessity and denials for approved drugs, the ACR is taking a large step towards protecting the rights of members when dealing with insurance companies.

Avoid Coding & Billing Nightmares

Melesia Tillman, CPC, CRHC, CHA  |  

Imagine getting a demand letter from a carrier that states your practice has incorrectly billed a procedure for the last year. To make matters worse, the carrier is asking you to return an overpayment, which amounts to thousands of dollars, and they want the full overpayment check within 45 days. Believe it or not, this scenario happens to rheumatology practices across the country.