Major metropolitan areas and two island territories saw the highest E/M denial rates in 2008, CMS claims data shows. Six of the top 10 high-denial geographic practice cost indices (GPCIs) are in big cities on the coasts; two are in the West and two are territories. NOTE: E/M denials were measured by compiling denials for all established and new outpatient visits, initial and subsequent hospital visits, and all consultation codes, which are no longer paid by Medicare.

Download this month's tool, a letter to help you explain the sustainable growth rate (SGR) to patients, from the Part B News website, www.partbnews.com. This tool, developed by Part B News, will help you articulate the impact of the SGR on Medicare reimbursements to patients. You are able to customize this tool with your letterhead.

You no longer have up to 15 to 26 months to file Medicare claims, CMS stated in an announcement April 1. The Patient Protection and Affordable Care Act (PPACA) reduced the amount of time to 12 months from the date of service (PBN 3/29/10).

CMS is reassuring you and your peers that you can use split-shared billing for services that would have previously been consultations. Providers were confused over some murky wording in a frequently asked questions (FAQ) document on the elimination of consult codes released in March (PBN 3/8/10). CMS stated, "The split-shared rules applying to E/M services remain in effect, including those cases where services would previously have been reported by CPT consultation codes."

Don't be too quick to stick modifier 59 (distinct procedural service) on claims that include two or more services. Look at other available modifiers to see if they are a better fit, or whether you should be using any modifier at all - that advice comes to you from your carriers and Medicare Administrative Contractors (MACs).

You can now appeal denials resulting from medically unlikely edits (MUEs), which gives you the ability to fight for payments when you can prove that exceeding the edit limit was medically necessary, experts say. CMS reversed previous policy on MUE appeals in Transmittal 652, which took effect April 1. Remember: MUEs are simple edits that only look at units of service performed on the same patient, on the same day, by the same provider.

Several retroactive provisions impacting your Medicare payments in the new health care reform law are proving difficult for CMS to quickly implement. Top CMS officials admitted as much while speaking during a provider conference call on April 13, saying they expect it to take another month or two to set new payment rates for localities that received payment hikes under health reform that are retroactive to Jan. 1.

[Last updated at 9:30 a.m. ET, 4/16/10] President Barack Obama signed an unemployment benefits extension bill late on April 15, which contained a measure postponing the sustainable growth rate (SGR) cut to Medicare reimbursements until May 31. Lawmakers in Washington must enact another pay-fix bill before June 1 or the 21% cut to your Medicare payments will go through.