Negotiating 11 limits to most favored nation (MFN) clauses in your private payer contracts will protect your rights to be fairly compensated for your physicians' services and will ultimately protect your practice's bottom line (PBN 11/22/10, PBN 12/6/10).

Your peers use the 1995 E/M guidelines more commonly than the 1997 guidelines, but that doesn't mean one is more useful or somehow better than the other, according to an unscientific Part B News reader survey. The two guidelines have different pros and cons (see related story), which may have influenced the survey results.

Your E/M revenue depends on getting full payment for the work your providers did, and that means choosing defensible code levels based on the right E/M guidelines. The choice between the 1995 and 1997 E/M guidelines from CPT must be made with lots of factors in mind, practice managers and coding pros say.

You're just weeks away from being able to furnish and bill Medicare's new annual wellness visit (AWV). With the Jan. 1 start date looming, CMS has clarified several lingering issues about the new service that will help your coding and billing efforts. The new information comes from Transmittal 2109, released Dec. 3, and from a CMS official's emailed responses to inquiries by Part B News.

Your budget meetings may soon be free of doomsday projections showing what it'd be like to practice medicine with devastating Medicare cuts in 2011. Democratic and Republican leaders in the Senate agreed to a 12-month Medicare payment fix bill, which is full of extra goodies to maintain current reimbursement rates at your practice. Example: It provides $200 million needed to reprocess claims paid earlier this year at updated fee schedule rates (PBN 9/27/10).

Participation in the Physician Quality Reporting Initiative (PQRI) in 2009 turned out to be a painful choice for many of your peers. Overall, one out of every five PQRI codes submitted to CMS on physician claims was used in error. In this special report, practices show you can easily earn quality bonuses by utilizing a registry.

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. We are a vascular surgery practice and the surgeon has seen the patient, but not in several years. The surgeon orders an annual ultrasound to see if the patient's arteries are blocked and require surgery. If surgery is not required, we tell them to come back for an ultrasound in a year. If surgery is required, we schedule the patient to see the physician to discuss treatment options. Is this acceptable?

Summary: Changes to relative value units (RVUs) in the final 2011 Physician Fee Schedule (PFS) will bring big changes next year, completely independent of what Congress ultimately decides to do with the Medicare cut now set for Jan. 1 (see related story). This chart examines 12 high-utilization services, dividing them into six that see the greatest payment increases and six that see the smallest increases, or in some cases a decrease, in the New Year.

You should already be reaching out to your clearinghouses and vendors to make sure you know what their plans are for the transition to the ICD-10 diagnosis coding system, now set to take place on Oct. 1, 2013, according to Tony Trenkle, director of CMS's office of e-health standards and services.

Medicare Administrative Contractors (MACs) confirm that your claims won't be rejected because of ordering/referring provider issues come Jan. 3 (PBN 11/15/10). CMS had previously announced when items and services require an ordering/referring provider and that provider is not in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) - the claim will not be paid.