CMS is taking pains to ensure you won't be paid by Medicare Part B for ambulatory surgery center (ASC) facility costs when treating skilled nursing facility (SNF) patients in the ASC setting. Whenever SNF patients receive ASC services during SNF stays covered by Part A, the ASC cannot bill Part B separately for facility costs, CMS says in Transmittal 1911 to the Medicare Claims Processing Manual.

A new CMS proposed rule to add more certification standards for electronic health records (EHR) systems could mean more confusion for you when you try to buy a system for your practice, experts tell Part B News. Currently you have only one certifying standard to look for, known as CCHIT (it's devised by the non-profit Certification Commission for Health Information Technology).

The uncertain future of Medicare payment has caused your peers to take steps to limit or reduce the number of Medicare patients on the daily schedule. The projected 21% cuts to Medicare payment hanging over your head and getting delayed a month or two at a time are cited as the main driver for reducing Medicare's role in your payer mix. Here are three ways to accomplish this.

You won't have to worry about Medicare payments dropping by 21% until Oct. 1 under a Senate-approved bill. The American Workers, State, and Business Relief Act of 2010 (H.R. 4213) passed with a 62-36 vote on March 10. The tax bill includes a section addressing the sustainable growth rate (SGR) Medicare cut, therapy cap exceptions and an extension of the minimum Geographic Practice Cost Indices (GPCIs) work floor of 1.000.

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

Q. Could you please give us guidance on when we should use modifier GG and when we should use modifier GH?

The Temporary Extension Act of 2010 extended the therapy cap exceptions, which expired Jan. 1, through March 31. Attach modifier KX to claims for outpatient therapy services provided to patients who've exceeded either of the two therapy caps. The 2010 caps are set at $1,860 for physical therapy and speech language pathology services combined; and $1,860 for occupational therapy services.

Summary: Duplicate services and documentation errors are driving denials of high-volume services, according to provider education articles on several carrier websites. The top services implicated include a low-level E/M code, common chest X-rays, EKGs and therapeutic exercises. NOTE: The percent figures above the bars show the denial rate for each service, first in 2006 and then in 2008.

You'll be able to offset some of the burdens of meeting meaningful use by charging fees to patients, CMS officials said during a public conference call on its electronic health record (EHR) incentive program. However, you won't be able to participate in both the EHR incentive program and the e-prescribing program simultaneously, officials said.

HHS wants a permanent fix to the sustainable growth rate (SGR) formula as much as you do, the agency's top official told a gathering of AMA members on March 2. Congress passed a one-month pay fix later the same day (see related story), but HHS Secretary Kathleen Sebelius underscored her agency's support for a final solution.

Expect reimbursements from private fee-for-service plans to continue to erode in the future as you'll "be at the mercy" of big commercial payers, experts told attendees of the AMA's National Advocacy Conference in Washington on March 3.