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In This Issue
Bonuses for Primary Care, General Surgeons
Informed Consent
Errors in 2011 CPT Book
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Practice Rx 
Is Your Practice Fiscally Fix?
Primary Care Providers, General Surgeons To Get Medicare Bonus Payments
More Bonuses


A little publicized aspect of the Affordable Care Act is quarterly bonus payments to Primary Care Providers and General Surgeons that began January 1, 2011 and continue through January 1, 2016.


Eligible for the ten percent primary care bonus are:

  • Physicians enrolled in Medicare with a primary speciality designation of family practice, internal medicine, pediatrics or geriatrics; and
  • Nurse practitioners, certified nurse specialists, or physician assistants who bill sixty percent or more of their time in outpatient based primary care procedures.

The bonus will be paid quarterly for outpatient primary care evaluation and mangement procedures. Hospital services do not qualify for the bonus.  For a complete list of procedures that do qualify visit MLNMatters MM7060.


General surgeons will be paid the ten percent bonus for major surgical procedures (those with 10 or 90 day global periods) rendered in HPSA shortage areas.  In order to qualify, the surgeon's primary designation with Medicare must be 02.  See MLNMatters MM7063 for more information.


These bonuses are paid in addition of HPSA bonuses.


Coders beware! 


Payment of either of these bonuses is NOT automatic. 


Your provider must have the correct speciality number listed with Medicare.  Don't be too sure this is not an issue for your practice.  In order to avoid seeing Advantage Plan members in the office, many providers have changed their speciality to hospital-based medicine which is NOT included as a bonus-eligible specialty code.  Check your NPI and PECOS profiles to be sure your provider's information is accurate.


In addition, you must include the provider's NPI number with the evaluation and management code on the qualifying procedure line of your claim form.  This option is not available with some of the Clearinghouses and EMRs.  Verify that your claims submissions have this information on them both when they leave your office and when they are submitted to Medicare. 


Further, in the case of general surgeons, modifiers must be included if your entire zip code is not listed as a healthcare shortage area. See CMS HPSA/PSA for listings. 


This is tricky billing.  Check and double check to be sure you are doing it correctly or leave your provider's ten percent bonus behind.


Are Your Informed Consent Practices Bullet-Proof?

Fine Print

Check the fine print in your informed consent forms

It's an unfortunate fact of a doctor's life that every patient must be viewed as a possible plaintiff in a malpractice suit.  And, juries like to compensate those with injuries whether or not the doctor has done anything wrong.


I'm often reminded of the story told by a friend who served on a jury a few years ago.  The plaintiff had stepped off a well-marked curb and fell as she left a restaurant.  The elderly plaintiff broke her leg in several places and sued the restaurant for damages.


Although the evidence was incontrovertible that the restaurant had marked the curb and provided a nearby ramp, my friend was still tempted to find in favor of the plaintiff just because the restaurant "could afford to pay."


How prepared are you if through no fault of your own a procedure has a negative outcome?


As part of your practice's New Year's resolutions, why not review your Informed Consent forms and accompanying handouts.  Are they comprehensive?  Would they overcome my friend's desire to find for the plaintiff because you can "afford to pay."


Many of the specialty societies are now providing language that may be included for your procedures.  Check the handouts you give your patients about procedures to ensure they include:

  • A description of the procedure,
  • Possible risks and benefits of the procedure,
  • Alternatives to the procedure, if any,
  • Aftercare instructions including contact information should the patient need assistance,
  • Estimated cost of the procedure.

Also be sure you have a signed, informed consent on file before every procedure that either lists the information above or refers to the handouts provided the patient.


We have a rudimentary form for your use at: 

(Email us if you would like a Word version of this document to modify.)


This form is designed to be accompanied with procedure handouts.


This form also includes a consent to film the procedure.  In a society where the average American spends 2.8 hours a day watching tv, (Bureau of Labor Statistics), a film of a well-performed procedure can serve as strong evidence in a malpractice case.

Errors in 2011 CPT 

Even the AMA makes mistakes.


For 2011, some of these likely impact your practice.

Liquid Paper
2011 CPT Errata


For example, in the original 2011 CPT book, the universally used add-on code 99356, Prolonged Physician Service With Direct (Face-To-Face) Patient Contact lists too many codes with which it can be paired.  The new subsequent observation codes 99224 through 99226 were initially listed as allowed codes.  They have been removed in the Errata publication.


Code 76413, a diagnostic ultrasound of the head and neck, refers to a deleted code in the original 2011 CPT book. 


The introductory paragraph for Cardiovascular Monitoring Services originally reads "do not require attended surveillance."  With the publication of the Errata, attended surveillance is now a requirement.


KLA recommends printing out the Errata from the AMA website and writing the changes directly in your CPT book.

Remember to check our blog, Keeping Up with KLA, for the news between our newsletters. 

Sharon Lusk, JD, CPA, CMC
KLA Healthcare Consultants
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Memphis, Tennessee 38133
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