Unfortunately, it's often up to you and your peers to break the news that the "insurance" card the patient is holding isn't insurance and you don't have a contract with that company. "The doctor will get caught in the middle. It's tough to tell a patient that the patient is not getting anything [for his money]," says Armand Feliciano, associate director of medical and regulatory policy for the California Medical Association in San Diego.

A new Senate proposal would provide CMS with the funds to finally reprocess your claims and account for Medicare Physician Fee Schedule updates made by the health care reform law in March. Senate Finance Committee Chairman Max Baucus (D-Mont.) included $175 million in the Job Creation and Tax Cut Act of 2010 to fund the reprocessing.

You are days away from dealing with the latest round of Correct Coding Initiative (CCI) edits, which are squarely targeted at minor supporting procedures often billed with musculoskeletal, digestive and urinary system surgeries, according to a Part B News analysis. CCI version 16.3 is the last version for 2010 and will take effect Oct. 1.

<p> Drug prices rebounded on CMS&#39;s Average Sales Price (ASP) list for the fourth quarter of 2010. On average, prices under the ASP plus 6% payment system increased by 1% after falling 0.7% during the third quarter of the year. You&#39;ll find 298 drugs increased in price while 205 had price decreases and 71 drugs remained the same.</p>

Download the September Tool of the Month, developed by DecisionHealth Professional Services, by clicking on the "Download File" link at the top of this article. This tool will help you establish an office policy for efficiently and effectively providing injections to patients. Use this customizable tool to inform the staff at your practice on how to manage injections during this flu season.

Summary: This chart looks at state-level utilization of the most common outpatient E/M services based on the latest CMS claims data, from 2008. To account for differences in state populations, the chart measures number of office visits billed per single enrollee. NOTE: The graph captures five high-utilization states and five low-utilization states, all with comparable Medicare patient populations. Population data is based on CMS beneficiary enrollment statistics. NOTE: The E/M services examined were 99201-99205 for new office visits and 99211-99215 for established visits.

This week's question is answered by Regan Bode, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services.

Q.  I have always looked for our physicians to state "critical care" in their notes before allowing them to bill critical care services. But I am not sure this is required - do they need to state critical care or can we still bill critical care when they only document their time with the patient if the documentation supports a critical care service. Can you direct me?

Your non-physician practitioners (NPPs) stand to benefit from several major provisions in CMS's proposed 2011 Physician Fee Schedule (PFS). But there's always room for improvement, according to two top NPP groups in their official fee schedule comments released earlier this month.

Hiring a certified registered nurse anesthetist (CRNA) straight out of school can cause headaches when you try to enroll the provider into the Medicare program. The CRNA needs to have a set of certifications and licenses before he or she can be enrolled and start receiving Medicare payments.