Those of you who have not received an E-scribe bonus (you will see the amount on your end of month report), still have time to earn a bonus for 2010 if you have the capability of reporting through a qualified hand held system or your EMR.

The code G8553, at least one prescription was created during the encounter and was transmitted electronically using a qualified system, can be reported a total of 25 times (visits) (for 2010) in order to earn the 2% bonus on your total Medicare payments.

Medicare is using the data collected throughout 2010 to determine if Medicare will apply penalties in 2012 and 2013 for not using E-scribe.

There are several options on the market for you, including free e-prescribing systems such as one offered by the National ePrescribing Patient Safety Initiative at www.nationalerx.com.

Remember, you can only report the e-scribe code during an eligible encounter which basically translates to a billable office visit. Prescriptions reported during a post-operative period with no billable encounter do not qualify.

You will not be eligible if less than 10% of your Medicare reimbursement comes from these codes, nor will you be eligible for an e-scribe bonus when you earn an EHR incentive Program bonus under the Medicare program.

Each of the following scenarios will tell you whether or not a prescription counts as e-scribing under CMS’s rules. The scenarios are based on CMS policy governing the program and the questions that were asked during a recent CMS teleconference.

Medically necessary reasons that support this scope include but are not limited to:

• Macroglossia preventing mirror exam
• Gag reflex preventing mirror exam
• Patient unable to cooperate to allow mirror exam due to age or mental condition
• Hoarseness, dysphasia, aspiration not clearly evaluated by indirect laryngoscopy
• Lesion identified by mirror exam needing further evaluation
• Anterior commissure not completely visualized by mirror exam
• Aspiration suspected that cannot be evaluated by mirror exam
• Evaluation of the larynx and immediate subglottis in patients for tracheal decannulation
• Acute airway obstruction

Remember, using a mirror, 31505 to perform an exam of the throat, oropharynx, etc. is part of the E/M service based on 1997 E/M guidelines.

Effective October 1, 2010, all NaviNet network providers must submit authorization requests through NaviNet. The following authorization must be done through the system:

• Medical/surgical procedures
• Cardiac rehab
• Chemotherapy/infusion
• DME
• Emergency hospital admission notification
• Home health
  • Dietitian
  • Home health aide
  • Occupational therapy
  • Physical therapy
  • Skilled nursing
  • Social work
  • Speech therapy
• Home infusion
• Outpatient speech therapy
• Pulmonary rehab
• Sleep studies

IBC no longer offers Security 65. Any patient that presents with this card does not have valid insurance. The new insurance is called Medigapsecurity-Plan A, B, C, F and N . This name and the plan the individual choose will be indicated on the right hand side of the card. Please ask the patient for updated information.

You can report imaging for needle positioning and injection assessment during kypholasty or vertebroplasty with a ‘26’ modifier if you are personally performing the guidance. Make sure it is clearly indicated in your operative report and state the type of guidance you use – CT or Fluoroscopy.

• 315.35 childhood onset fluency disorder
• 488.01 flu due to identified avian flu virus w/pneumonia
• 488.02 flu due to identified avian flu w/other respiratory manifestations
• 488.09 flu due to identified avian flu w/ other manifestations
• 488.11 flu due to identified novel H1N1 flu w/pneumonia
• 488.12 flu due to identified novel H1N1 w/other respiratory manifestations
• 488.19 flu due to identified novel H1N1 w/other manifestations
• 784.52 flu disorder in conditions classified elsewhere

Remember to report, on your fee ticket, every time you use your electronic e-prescribing. There may be a bonus for doing so. You must report at least 50% of the Medicare scripts via e-scribe to potentially qualify for the bonus. If the “G” code is not on your form – write ‘E-Rx’ somewhere on the form and we will report the “G” code with the claim.

Financial difficulty is a discouraging fact of modern economic times. While you remain concerned about your patients’ well being, you also have to keep your practice financially stable.

When a patient hits a rough patch, it’s hard to resist the temptation to waive copay, deductibles or even write off balances. The problem, waiving deductibles and copayments can violate several federal laws, including the False Claims Act, anti-kickback statutes and compliance guidelines for practices. You may also violate payer contracts which could result in your removal from a provider panel.

It’s difficult to say what carriers deem red flags in determining which services to audit. However it is true they use sophisticated tools to profile you. The most common red flags from an auditing eye are:

• The same diagnosis for every visit. Each encounter must correlate to the patient’s chief complaint and the indication for the visit. It is unbelievable that the same diagnosis would be used for every visit from an auditing eye.
• Billing the same CPT code over and over. Remember that bell curve…it still applies today. No practice or physician should be reporting all 99213′s for every patient.