The Net Guide: Billing & Reimbursement

MDNG Primary CareJuly 2010
Volume 12
Issue 7

We searched the Internet for billing and reimbursement resources so you don't have to.


Concierge Medicine: The Benefits and Drawbacks of Personal Health Care

Credits: 1.75


Expires:January 20, 2011


Featuring several physician experts in practice management and concierge medicine, this activity defines concierge practice and how it works; explains the differences between cash-only and concierge models; compares the pros and cons of the model for both patients and physicians (not least of which is the concept of being paid up front); reviews what considerations one must make before moving to the concierge model; and explores the legal and ethical issues surrounding this relatively new form of practice. Enter the program title in the search window at, click the “go” button, and select “physician” as your profession to access the program.

Link Code: a12735

Health Care Providers Brace for Medicare Audits

Credits: 1.00

Fee:$10 (Massachusetts Medical Society members)/$20 (non-members)

Expires:February 22, 2011


With all states now on board with Medicare’s Recovery Audit Contractors (RACs) program—created as an attempt “to detect and correct administrative and resource waste in the Medicare program”—physicians are encouraged to participate in this program to learn about the structure of RACs, numerical burdens of RACs, possible fiscal and legal consequences of RAC audits, and where potential resources focused on RACs can be found.

Link Code: a12736

The Cash Only Practice: Reinventing an Old Practice Model

Credits: 2.00


Expires:October 29, 2010


Physicians who don’t want to deal with the billing and reimbursement issues that come with a “standard” practice should definitely participate in this activity, which defines cash-only practices and how they work. Additionally, the activity differentiates cash-only from concierge practices and explores pros and cons of the former, what to consider before making the switch from standard practice, and “the legal and ethical considerations of a cash only practice in the context of its larger societal impact.” Enter the program title in the search window at, click the “go” button, and select “physician” as your profession to access the program.

Link Code: a12737



Designed “to help users avoid denials, save time, and get answers to medical coding questions on a variety of code sets,” this site separates itself from others by performing searches through numerous code sets—including ICD-9-CM vol 1 Diagnosis codes, CPT codes and descriptions, ICD-10-CM/PCS codes and descriptions—with a single search. The one catch: annual or monthly subscriptions are required, running $334.24 and $29.95, respectively.

Link Code: a12715

FREE ICD 9 Coding

Claiming to be the “#1 diagnosis coding website,” this aesthetically unappealing site provides a surprisingly well-organized system for searching for not only ICD-9 codes, but also CPT and HCPCS codes. Users can perform searches for specific topics, or choose from categories and sub-categories to narrow down the search and pinpoint the exact code they require. Notes are provided throughout to aid in the search.

Link Code: a12716

ICD-10 Code Translator

The American Academy of Professional Coders provides this resource, which allows users to compare ICD-9 codes to ICD-10 codes in an attempt to help in mapping the expansion from 17,000 to roughly 141,000 codes. After entering a code in the search window (ICD-9 or ICD-10), users are presented with the corresponding code from the other set, along with its descriptor. Site visitors are urged to note that the tool only coverts ICD-10-CM codes, not ICD-10-PCS.

Link Code: a12717

Public Policy: Medicare Physician Reimbursement — MGMA

Offered by the Medical Group Management Association, this site serves as a repository of Medicare physician reimbursement news dating back to 2006. News from 2010 covers the 2011 proposed physician fee schedule, the 21% Medicare pay cut, and more. A free registration is required to view most materials.

Link Code: a12718


Pilot Study of Providing Online Care in a Primary Care Setting

Journal:Mayo Clinic Proceedings(June 1, 2010)

Authors:Adamson S, Bachman J

Purpose:“To study the use of e-visits in a primary care setting.”

Results:A far-ranging number of conditions were able to be cared for using the online care model, with minimal message exchanges thanks to the use of structured histories. Further, care that was previously provided for free or by nurse triage and subject to malpractice could be documented and billed.

Link Code: a12758

Reimbursement and Value-based Pricing: Stratified Cost-effectiveness Analysis may Not Be the Last Word

Journal:Health Economics(June 21, 2010)

Authors:Hawkins N, Scott D

Purpose:To test the hypothesis that “when manufacturers are price setters, reimbursement or [value-based pricing (VBP)] based on stratified cost-effectiveness analysis may not be optimal.”

Results:“Negotiation regarding trade-offs between price and coverage may lead to improved outcomes both for health-care systems and manufacturers compared with processes where coverage is determined conditional simply on stratified cost-effectiveness at a given price.”

Link Code: a12759

Saving Billions of Dollars—and Physicians’ Time—by Streamlining Billing Practices

Journal:Health Affairs(June 2010)

Authors:Blanchfi eld B, Heffernan J, Osgood B, et al.

Purpose:To explore the hypothesis that a “single transparent set of payment rules for multiple payers, a single claim form, and standard rules of submission, among other innovations, would reduce the burden on the billing offices of physician organizations.”Results:This hypothetical model, on a national level, would “translate into $7 billion of savings annually for physician and clinical services. Four hours of professional time per physician and five hours of practice support staff time could be saved each week.”

Link Code: a127510


HIPAA 5010/ICD-10 Straight Talk — Planning for 2010 and Beyond

Originally held as a webinar on March 30, 2010, this archived webcast features three experts who discuss what can be learned from other health plan efforts, planning “considerations for addressing ICD-10 compliance,” and addressing the ICD-9/ICD-10 Crosswalk.

Link Code: a127111

ICD-10: Much More than a Regulatory Mandate - Webcast for Providers

This hour-long webcast from May 17, 2010, meant to help providers understand and prepare for ICD-10 compliance, “provides an overview of the requirements and lessons learned from current ICD-10 conversion projects.” Because the transition will be highly complex and may cause signifi cant changes in processes, technology, and staff, the webcast also reviews the best ways to obtain effi cient and effective conversion “and potential process improvements through effective ICD-10 implementation.”

Link Code: a127112


How Do Doctors Get Paid?

Though written by SoloDoc author AkiFox—with the help of Megan Lewis, MD, a family physician in rural Colorado, and Albert Fuchs, MD, an Internist in Beverly Hills—back in September 2008, the information still holds true. Using the experience of dining at a restaurant as an analogy for receiving care in a physician’s office, the blog post explains how frustrating it is for physicians to receive reimbursement and why office visits are forced to be handled in such short lengths of time.

Link Code: a127213

A Right Perspective: Doctors Can’t Take 21% Cut from Medicare

Directed at patients, this column from the Memphis Commercial Appeal’s Marilyn Loffel provides a couple analogies that help explain the Medicare reimbursment cut and how it will affect both patients and their physicians—leading to what she says will be many physicians either opting out of Medicare or leaving practice altogether, either way leaving Medicare patients without a doctor. Loffel also encourages readers to contact their representatives in Congress and tell them not to support the cut.

Link Code: a127214

From the Network

New Medicare Policy may Have Unintended Consequences in Clinical Practice

Residents who were informed about the Medicare “no pay for errors” rule were less likely to choose the most appropriate clinical practice choices in response to clinical vignettes, according to findings from a study published in the Journal of General Internal Medicine.

Do Reimbursement Cuts Affect Treatment Patterns?

Physicians may modify their treatment and prescribing patterns to offset cuts in Medicare payments, according to findings from a study published in Health Affairs, which cautions that payment reform has “real consequences” and should be undertaken carefully.

The High Cost of Undercoding

Fear of chart audits can lead billing departments to undercode -- and that may be costing you revenue. Benchmarking and analytical tools can help identify undercoding in your practice, to ensure you don’t leave money on the table.

UPDATE: Senate Agrees to Delay 21 Percent Medicare Payment Cut

Senate lawmakers reached an agreement to delay the 21% reduction in Medicare claims reimbursements, on the day the cuts were scheduled to going into effect. The bill now moves on to the House for approval.

AMA: One in Five Claims Are Processed Incorrectly

The nation’s five largest health insurers processed 20% of claims incorrectly in 2009, a new study shows. The inaccuracies resulted in backlogs in processing, anger and confusion among patients, and wasted time and delayed payments for physicians.

Physician Practices Are Merging at a Record Pace, Driven by Health Reforms

Physician practices are consolidating at a record pace, driven by payments cuts embedded in the federal health reforms, a new survey fi nds. Small cardiology practices, which have seen the deepest cuts in Medicare payments, are among the most likely to be acquired by larger providers.

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