Your Medicare payments should increase by 1% in 2011, the Medicare Payment Advisory Commission (MedPAC) argues in its annual report. However, MedPAC's recommendations are nonbinding, even though it makes its recommendations directly to Congress.

This week's question is answered by Sean Weiss, CPC, vice president, DecisionHealth Professional Services.

Q. When a doctor who is aware of a patient's financial situation recommends that we waive the patient's co-pay and/or deductible, do we also need to gather documentation that shows the patient is a true hardship case?

Billing E/M visits in lieu of consultation codes will yield lower reimbursement in most cases. But now CMS states you can bill consult scenarios as a split/shared service - a departure from previous agency policy fueled by the fact that the agency no longer pays these services as consults, but as regular E/M services. 

Put your new non-physician practitioners (NPPs) through a gradual integration process when they join your practice to get the best results, experts say. Both your patients and your staff need time to adjust to newly added NPPs, especially when you've never used NPPs before. 

Summary: Practices that consistently see higher denials on consults than E/Ms may actually see less of a payment reduction now that consults are gone, and vice versa. This also holds true for the consults and E/Ms billed by your practice's non-physician practitioners (NPPs). NPPs billed nearly 10.3 million E/M services and about 650,000 consults in 2008.

This week's question is answered by Sean Weiss, CPC, vice president, DecisionHealth Professional Services.  

Q.   Can non-physician practitioners (NPPs) such as physician assistants (PAs) or nurse practitioners (NPs) have reciprocal billing arrangements with one another if all of the PAs/NPs are enrolled in Medicare?

We are getting denials when we bill hemodialysis with a subsequent inpatient visit code with modifier 25. The denials state the service isn't covered when performed during the same session. Can you tell us what we're doing wrong?

Use an attestation statement or signature log to properly identify and authenticate the source of initials or an illegible signature left on a medical record (see story). Here's an example of an attestation statement from CMS.

Most of your peers plan to implement an electronic health records (EHR) system sometime in the next three years, with more practices leaning toward sooner rather than later, according to a Part B News analysis of a recent Medical Group Management Association (MGMA) survey. What's more, a sizeable majority of practices with EHRs - or those in the process of implementing one - expect to qualify for federal incentive dollars by the end of next year.

All specialties bill more E/M codes now that consultation codes have been eliminated. However, the transition from consult codes to E/M codes is likely to have positive and negative effects on specialties depending on what their average denial rates were for E/M services and consult services.