Go straight to your carrier's local coverage determinations (LCDs) or CMS's national coverage determinations (NCDs) when you receive a denial stating a claim lacked medical necessity.

When your providers order supplies or medical equipment, CMS will deny the claim automatically if their enrollment information isn't in its online Provider Enrollment Chain Ownership System (PECOS). This strict new rule goes into effect Jan. 1, 2010 - right now you just get a warning (see story).

I'm billing for a doctor who works in an independent, free-standing urgent care center (POS 20) and I'm not sure which E/M codes I should use. The facility is open 24/7 so it's more like an emergency room. Do I have to use the usual office visit codes? If so, will I need to track each patient's visit and then bill the established patient codes if he/she comes back within the three-year period?

Increase your reimbursements for non-physician practitioners (NPPs) by getting them involved in reporting Physician Quality Reporting Initiative (PQRI) and electronic prescribing programs. It's not just physicians who are eligible for bonus payments.

Non-physician practitioners (NPPs) are seeing a high denial rate on low-level E/M codes, according to an NPP Report analysis of the latest CMS claims data. 99212 (office/outpatient visit, est., $37.15) was denied an astounding 20.2% of the time in 2008 - that's more than one denial for every five claims submitted. 99211 (office/outpatient visit, est., $18.75) had a 40.6% denial rate in 2008.

Physical therapy and chiropractic manipulation codes remain the fastest-growing but most often denied services for non-physician practitioners (NPPs), according to an NPP Report analysis of the latest CMS claims data.

Can an NPP bill a time based code "incident-to"? I've heard various opinions on this and would like a source from Medicare that gives the correct answer.

Your staff is not immune to the highly contagious swine flu virus now widespread in 37 states, according to the latest data from the Centers for Disease Control and Prevention (CDC). The difference is that when your patients get sick they'll count on your practice. You need a plan for how to run your practice when half your staff - or their children - get the swine flu.

Now is the time to make sure you're ready to act quickly when you receive a letter from your RAC. You've likely not heard a peep from your RAC as they have been slow to send out demand letters (PBN 9/21/09). But experts have recommended you develop a RAC response team to respond to RAC letters and deadlines (PBN 3/9/09).

Take a look at hyperbaric oxygen chambers for wound therapy treatments at your practice - more and more of your peers are billing these services, a Part B News analysis shows. CMS allowed billing physician attendance and supervision of hyperbaric oxygen therapy (99183, $189.35) for lower extremity wounds in diabetics in 2003 (PBN 1/13/03). The volume of services billed has more than doubled since then - with 465,406 services in 2008, up from 212,258 in 2002.