Last week, we told you in Part B News that a new conversion factor will lower payments for some Medicare physicians, but increases to work and practice expense geographic practice costs index (GPCI) values have raised payments for other physicians. But we also mentioned CMS adjusted relative value units (RVUs), which in some cases will cost you and your peers millions of dollars in lost revenue this year.

Your Medicare reimbursements are set to drop 21.3% on Monday, June 14, for all services done on or after June 1, unless the Senate approves a temporary payment fix before that date - and time is running short. The Senate had yet to proceed with a final vote on a House-approved, 19-month pay fix as of June 10. The Senate had proposed and voted on amendments to the bill, none of which would modify the Medicare reimbursement provision. The earliest the Senate could vote on the bill is June 15.

A doctor performs a consult in the office. Three months later the patient is admitted to the hospital and a second doctor asks for a consult. Can the consulting doctor bill another consult or should he bill a subsequent care code since the patient is established? I'd like to know the answer for both Medicare and private payers.

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Denial rates for most of Medicare's top-billed codes have fallen despite all of them being billed more often year after year for nearly a decade, a comprehensive Part B News analysis shows. However, there are a few notable exceptions where denials have worsened.

Once you know you have providers without updated information in the Provider Enrollment Chain Ownership System (PECOS), you must move quickly to get them in by July 6. After that date, CMS is supposed to begin rejecting claims for services ordered/referred by providers not in PECOS. Use these four tips to get your enrollment application processed without delay.

Palmetto GBA will transition to serve as Medicare Administrative Contractor (MAC) Jurisdiction 11, comprised of North Carolina, South Carolina, Virginia and West Virginia, the carrier has confirmed with Part B News.

Thanks to members of Congress, you need not worry about enforcement of the Red Flag Rules on June 1. In a May 28 press release, the Federal Trade Commission (FTC) announced it would delay enforcement until Dec. 31, 2010. But be warned: Enforcement could still start before the end of the year.

You've heard a lot by now about how the historic Patient Protection and Affordable Care Act (PPACA) will revolutionize health care for consumers, employers and others. What has received little attention, however, is how the new law will alter your dealings with private payers.

Your best bet to avoid costly claim rejections is to ensure that all your providers are up-to-date in CMS's Provider Enrollment Chain Ownership System (PECOS) by July 6, agency officials say. You also need to confirm the PECOS status of providers who refer patients to you or order any covered item or test prior to July 6; you won't be paid for these if they're not in PECOS.