Your Medicare payments are still in jeopardy. Congress returned to Washington on Nov. 15 after mid-term elections and had not put forth a bill to fix the broken Medicare payment formula as Part B News went to press. A 23% cut will reduce your Medicare reimbursements if lawmakers fail to act by Dec. 1. Another cut, set for Jan. 1, would drop payments by 30% when compared to current rates.

You still don't know whether your Medicare payments will fall 23% in three weeks as a lame-duck Congress wraps up its term (see related story). Whether the massive pay cut will hit remains uncertain, but you can bet on Medicare payments staying flat at best, experts say.

Be on the lookout for clauses in your managed care contracts that require you to accept from the payer the lowest rate you give any other payer. These provisions, known as most favored nation (MFN), cost-containment or prudent buyer clauses, restrict your ability to contract with other payers and force you to get paid less - sometimes a lot less - than you had originally agreed to when you signed the contract.

You stand to earn up to $174.78 for every single Medicare patient whose a member of your practice next year, and $116.52 for them every year afterward (assuming there is no pay cut) - all thanks to the annual wellness visit (AWV). Your providers will have to perform one additional element during the visit to earn the money, but they'll also be able to bill related preventive services more efficiently because of changes in the final 2011 Physician Fee Schedule (PFS).

A practice inadvertently submits G8553 (at least one prescription created during the encounter was generated and transmitted electronically using a qualified electronic prescribing system) on claims during the 2010 E-prescribing Incentive Program year. The practice later discovers it did not have the required certified or qualified e-prescribing system. What do you do next?

Download this month's tool - an Annual Wellness Visit Encounter Form brought to you by DecisionHealth Professional Services - to help you efficiently provide Medicare's new annual wellness visit service. 

Denials cost practices more money in 2009 than 2008, and specialties that perform high-value procedures top this chart of dollar losses per provider. This data shows the 10 specialties that saw the greatest per-provider dollar losses to denials in 2009 and compares their losses to 2008.

I read your Oct. 25 story on the new observation codes for 2011 (PBN 10/25/10). The new codes 99224-99226 are said to be used as  subsequent observation care between 99218-99220 (which to me makes sense) and codes 99221-99223 which are inpatient codes (this doesn't make sense to me). Why wouldn't we continue to use 99231-99233 for subsequent inpatient hospital care?

CMS will ask you to collect more money upfront from your Medicare patients in 2011. The Part B deductible will be $162 next year, a 4.5% increase from the current rate of $155. TIP: Remind your patients when scheduling appointments to be ready to pay the $162 deductible after Jan. 1. Several of your peers reported difficulties collecting the amount earlier this year after the deductible had jumped nearly 15% (PBN 2/1/10).