You'll see a retroactive payment increase averaging between roughly 1% and 3% if you practice in one of more than 50 localities affected by a geographic price cost index (GPCIs) adjustment in the health care reform bill. The Patient Protection and Affordability Act (PPACA) retroactively restores the minimum work GPCI factor of 1.000 to the Medicare payment formula. The floor expired Jan. 1, so providers in 54 geographic areas experienced decreases in payment because their work GPCI dropped below 1.000.

The passage of historic, controversial health reform legislation and its costs have complicated the temporary payment fix you and your peers have come to expect from Congress every year, experts tell Part B News. The highly partisan debate over reform and its costs are largely responsible for just a one-month pay fix and the need for immediate action again to stave off the 21% cut mandated by the sustainable growth rate (SGR) formula, a health care industry expert says.

The massive, 2,400-page health care reform bill adopted over the weekend means new opportunities and challenges for your practice. The Patient Protection and Affordable Care Act (PPACA) passed the House of Representatives late Sunday night by a 219-212 vote. The White House says President Barack Obama is expected to sign PPACA into law on Tuesday (UPDATE: read our most recent coverage here).

Your practice will see lots of new opportunities from the massive, $1 trillion health care reform bill signed into law March 23, but you can expect to deal with new fraud mandates as well. The landmark legislation makes a number of changes to the Medicare program that will impact your practice over the next several years. 

Congress may miss another deadline, leading to a devastating 21% cut to Medicare reimbursements. The House of Representatives and Senate had not yet agreed on a bill delaying the sustainable growth rate (SGR) cut to your payments set for April 1 as Part B News went to press.

Your efforts to implement an electronic health record (EHR) system and snag up to $44,000 in federal bonus money could get a big boost from new, government-funded entities called health information technology regional extension centers (RECs).

The Patient Protection and Affordable Care Act includes several anti-fraud, abuse and waste provisions, including reducing to 12 months the amount of time you have to submit a claim to Medicare. The new law is projected to save Medicare billions of dollars through fraud prevention.

Here's a bullet list of key changes that the health reform bill (dubbed "The Patient Protection and Affordable Care Act") will make to Medicare program fees.

Brace yourself for nearly 2,200 new Correct Coding Initiative (CCI) edits that take effect April 1 and largely target codes billed by ophthalmologists and optometrists. Most of these are new edit pairs that permit unbundling surgical services with a modifier. For comparison, CCI 16.0 had almost 42,000 changes, which means version 16.1 has 95% fewer changes.

Summary: Denial rates for both diagnostic and screening colonoscopies crept upward for the five specialties that bill the vast majority of these services to Medicare, an analysis of the most recent claims data shows. Most of the increases in denials are small, but consistent across the three-year period from 2006-2008.