Don't be surprised when your new provider receives a reminder regarding enrollment from CMS soon after he or she begins providing services. CMS wants providers to close out enrollment at previous employers by using the CMS-855I application, according to Transmittal 307.

Providers heavily utilized these measures when attempting to meet requirements to earn bonus payments from the Physician Quality Reporting Initiative (PQRI) in 2008 (see story, pg. 1), according to a Part B News analysis of CMS billing data for that year.

This week's question is answered by Regan Bode, CPC, senior consultant for DecisionHealth Professional Services.

Q.   Help us settle this dispute. A colleague insists it could be fraud if we don't take and note the patient's vitals at every office visit. I can't find anything in the 1995 E/M guidelines that indicates we must get the patient's vitals for every visit and I can't find anything on the Medicare website. Could you direct us to some guidance?

The final version of the 2010 Medicare Physician Fee Schedule (PFS) will eliminate consultation codes and sets the conversion factor at $28.4061 -- a drop of 21.2% as mandated by the sustainable growth rate (SGR) formula.

When your providers order any kind of supplies or durable medical equipment (DME), all their enrollment information must be present in CMS's Provider Enrollment Chain Ownership System (PECOS). If they aren't, you should be getting a warning notice from your carrier - and starting Jan. 1, 2010, you'll get an instant denial on every DME claim filed on behalf of a provider not in PECOS.

Attempts in the Senate to kill the 21.5% cut to Medicare reimbursements set for next year and enact a more permanent fix failed on Oct. 21 - leaving you and your peers about 75 days from the nightmare scenario of a crippling pay decrease.

Check your mail and your bank account: Physician Quality Reporting Initiative (PQRI) bonus checks for 2008 have started to arrive. You may find some of the same troubles from last year when you try to access your PQRI feedback report to determine which doctors successfully earned the bonus.

You and your peers left millions of dollars behind in 2008, thanks to staggering denial rates on four commonly billed allergy testing services, a Part B News analysis shows (see chart, below). The rising denials for 95004 and 95024 are especially troubling, since they make up the bread-and-butter of testing payments for allergy practices, experts say.

One positive result should you lose the ability to bill consultations is that you won't have to follow the rigid documentation rules for the service any more. Keep in mind: CMS has not confirmed it would eliminate consults, but the agency could do so in the 2010 Medicare Physician Fee Schedule later this month (PBN 8/24/09).

Imaging utilization by primary care practices has been falling over the last three years, according to a Part B News analysis of the latest CMS claims data. The chart below shows a specialty-by-specialty breakdown of imaging utilization in 2006 and 2008.