CMS released changes to the Lab National Coverage Determination (NCD) software, effective Oct.1, 2010, to be implemented Oct. 4, 2010. For more information see Transmittal 2001, Change Request 7057, to the Medicare Claims Processing Manual released July 16, 2010.

This chart examines how the level of E/M codes billed to Medicare differs by state, based on ratios that compare the most common E/M service billed for both new and established patients, the level 3 visit, to the two lower and two higher levels, based on 2008 CMS claims data. The low-level codes represent levels 1 and 2, while the high-level codes reflect a combination of levels 4 and 5.

You must consider a myriad of potential issues, including the impact of the finalized Electronic Health Record (EHR) Incentive Program, when your practice weighs the pros and cons of joining forces with another group, experts tell Part B News.

You can bill Medicare for alcohol and substance abuse intervention services when patients demonstrate symptoms of related illness or injury and your providers do a thorough job documenting the encounters. A July 6 educational article from CMS reminds you about these services, which are technically termed "structured assessment and brief intervention" (SBIRT). They allow your physicians and most non-physician practitioners (NPPs) to bill for face-to-face time spent with patients suffering illness or injury due to alcohol or non-tobacco substance abuse.

When you're having payment problems with a Blues plan, you may have an additional weapon in your arsenal to challenge the plan. Most Blues plans signed on to a national agreement to settle class action litigation regarding their activities. If their current activity violates those agreements, you have the right to file a complaint with a third party to help you out.

Watch for letters questioning your enrollment status from your carrier. A medical association reports multiple physicians have received notices that their enrollment isn't valid, despite these physicians appearing on CMS's ordering/referring master list (PBN 7/12/10).

Two-thirds of your peers believe they've positioned their practices to earn electronic health record (EHR) program incentives within the next two years, according to a Part B News reader survey. However, the incentive amount - up to $44,000 per physician from the Medicare program - won't cover implementation costs incurred by the practice, readers say. Just 22% of respondents believe the bonus payments will fully compensate the physicians for participation in the program (PBN 7/12/10).