Changing Medicare's payment formula to break the cycle of large annual pay cuts and temporary fixes to your payments remains a top priority on Capitol Hill, Washington insiders tell Part B News. Top lawmakers are discussing options - including a multi-year pay fix - to avert the 21% cut to your Medicare reimbursements now set for March 1.

After a slow rollout, Recovery Audit Contractors (RACs) appear to be ramping up targets aimed at outpatient services furnished by you and your peers. Region D RAC HealthDataInsights (HDI), overseeing states in the West, is now targeting services billed for a new patient when the provider had seen the patient within the last three years.

Expect reports generated from consultation services to continue even though specialists are no longer required to draft a letter or note to the referring physician, practice consultants say. Under old billing rules, your physicians were paid more for consults because the services required more work and time.

Identify your patient's insurance plan and determine whether the payer still accepts consultation codes (see related story). The consult change does not apply to Medicare Advantage (MA) plans. However, some MA plans are following Medicare's lead to eliminate consult codes (99241-99245, 99251-99255). Others are signaling they will continue to bill consults.

CMS will require its contractors to make sure your providers can legally work in the United States, according to an update to the agency's enrollment policy. Contractors will identify physicians and non-physicians who indicate in section two of an enrollment application they were born in a foreign country.

This chart ranks the difficulty of the remaining 12 proposed meaningful use requirements. There are 25 requirements; the first 13 were ranked in the first round of this feature (PBN 1/18/10). Rankings and analyses are subjective, based on in-depth interviews with Robert Tennant, senior policy advisor for the Medical Group Management Association's (MGMA) Washington office, Carolyn Hartley, president of Physicians EHR, a Cary, N.C. company that helps practices adopt electronic health record (EHR) systems and Scott Decker, CEO of NextGen Healthcare Information Systems, an EHR vendor headquartered in Philadelphia. 

Summary: Denials for 10 of the most common surgery codes billed to Medicare have fallen almost across the board from 2007 to 2008, reversing a trend of slight increases in denial rates from 2006 to 2007. NOTE: The codes were selected based on utilization figures and associated specialty, including ambulatory surgery centers (ASCs), to ensure that a variety of surgical procedures were represented. The bold numbers above the bar graphs indicate the change in denial percentages over the one-year period. NOTE: The dollar amounts for each code below are based on the 2010 Medicare Physician Fee Schedule.

This week's question is answered by Margie Scalley Vaught, CPC, coding content specialist for DecisionHealth.

Q. Is it possible for us to bill G0250 for the interpretation of a patient's home test results?

Nurse practitioner (NP) groups are protesting an AMA report that warns lawmakers and state officials about NPP scope-of-practice limits and clinical qualifications for services often performed by physicians, NPP Report has learned.