You'll know you're not in CMS's Provider Enrollment, Chain and Ownership System (PECOS) when you receive a letter from your carrier this month. Two-page letters appearing on your carrier's letterhead are being mailed in standard-size envelopes to the practices and providers who aren't in PECOS.

Be on the lookout for silent preferred provider organizations (PPOs) - private insurance companies that underpay you without your permission. You'll lose out on thousands of dollars - maybe without your knowledge - if you're not careful.

You know you need to buy and implement an electronic health records (EHR) system soon to take advantage of federal incentives worth up to $44,000 per provider starting in 2011. The payout goes down the longer you wait (PBN 3/8/10). But what do you know about EHR systems right now - can you visualize what you'll get?

You're looking at yet another temporary Medicare payment fix - this one with a 2.2% payment increase at least - after Senate negotiators failed to gain enough support for a longer term 19-month pay fix bill. The 2.2% increase, which still has not passed Congress as Part B News went to press, would be retroactive to June 1 but would expire Nov. 30.

CMS will give Congress three extra days to pass a payment fix before processing claims with a 21.3% cut, an agency official announced. Your contractors will now hold claims submitted for the month of June through Thursday, June 17. CMS will lift the hold on June 18. Claims with a date of service before June 1 will continue to be processed without the cut.

You now have a clear road to payment for every hour of pulmonary rehabilitation performed, a change long sought by specialists and previously covered only by some Medicare contractors under varying local coverage determinations (LCDs). But pulmonary rehabilitation (PR), like its sister services cardiac and intensive cardiac rehabilitation (CR and ICR), isn't just a free new billing opportunity, experts say.

Summary: Different specialties often see certain types of services dominate their billing, such as primary care with E/M codes and radiology with imaging tests. This trend is supported in most cases by the data, though there are a few mild discrepancies where greater utilization doesn't result in particularly low denial rate and vice versa, where specialties with low or moderate utilization don't have very high denial rates.

This week's question is answered by Sean M. Weiss, CCP-P, ACS-EM, CPC, CPC-P CCA-P, vice president and chief compliance officer of DecisionHealth.

Q.  Our lab has a certificate of waiver but Medicare has rejected our use of 87081 (culture screen only) when the doctor collects a culture specimen and uses a culture plate to grow it out. The remittance advice says we are not approved to use this code. How do we get approved or is there another code we should use instead?

You and your patients stand to benefit from complete Medicare coverage of more than 30 preventive services that received recommendation grades of ‘A' or ‘B' from the U.S. Preventive Services Task Force (USPSTF). Thanks to a provision in the health reform law, Medicare will be covering these services without requiring shared payment of any kind from patients, which means you won't need to collect copays or worry about billing patients who haven't yet met their Medicare deductible.

Prepare now to take advantage of a new covered service poised to deliver a significant revenue boost to your practice in 2011 - a fully covered annual wellness visit for all Medicare patients with a waived copay and deductible. This new billing opportunity comes thanks to a provision in the health reform law. A fictional five-provider primary care practice with 5,000 Medicare patients could gain as much as $450,000 a year for providing the service to all eligible patients.