Part B Insider (Multispecialty) Coding Alert

Plus: Almost 40 percent of providers saw pay slashed by 1.5 percent due to PQRS non-participation.

If you’re performing CT scans, it’s a good time to check your documentation. CMS recently found a 16 percent improper payment rate among practices reporting these services, and the agency took a moment to remind CT scan practitioners about the importance of accurate documentation in a Medicare Learning Network Podcast on the topic.

“Insufficient documentation caused more than 99 percent of the CERT review contractor identified improper payments,” CMS reps said on the podcast. “Insufficient documentation means that something was missing from the medical records. Missing orders caused over half of the payment denials.”

To prevent denials, the CMS staffer advised that you first check the ordering practitioner’s order to ensure that it’s signed, and then retain a copy of that order. In addition, you should document the fact that you performed the CT scan, and retain a copy of the CT scan report from the radiologist or interpreting physician. If your Medicare contractor asks for your documentation, send along the original order for the scan, the ordering practitioner’s progress notes documenting the reason for the scan, the medical records that you created during the scan and the final report of the scan that the radiologist or interpreting doctor provides.

In other news…

Almost half a million providers forfeited 1.5 percent of their pay this year, CMS reports.

Forty percent of eligible professionals (totaling 469,755 practitioners) are subject to the 1.5 percent PQRS payment adjustment this year due to their 2013 reporting experience, according to the April 8 CMS document, “2013 Reporting Experience Including Trends (2007-2014)” on the PQRS and EHR incentive programs. 

Most of the doctors who will take the 1.5 percent hit this year didn’t submit any PQRS data in 2013, while the remaining two percent of practices attempted to participate but did so improperly, the report indicates.

Among those practices that did participate in the program, the incentives were robust. “Incentive eligible professionals earned a combined $390,663,021 through PQRS and the e-prescribing Incentive Program in the 2013 program year,” CMS says in the 101-page document.

Resource: To read the document, visit the CMS website at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/AnalysisAndPayment.html.

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