Senate lawmakers have yet to agree on legislation to avoid the 21.5% cut to your Medicare payments set for 2010 as public debate rages over other health reform initiatives such as end-of-life planning and creating another public health insurance option.

This chart shows 10 specialties with the highest growth in median physician compensation from 2004 to 2008, based on survey data from the Medical Group Management Association (MGMA). Overall, the best-paid specialties in this list tended to make greater gains than those less paid.

Can a specialist called in to the emergency department (ED) bill codes 99281-99285 (emergency department visit, $20.20-$170.23)? I've heard those codes are reserved for the ED physician.

You and your peers are billing more physical therapy (PT) services to Medicare than ever before, and the denial rate has gone up right alongside in the last few years, according to an NPP Report analysis. The two most commonly billed codes, 97110 and 97140, were billed 43 million times in 2007, up 14% from 37.7 million times in 2005. Over the same period, their denial rates jumped into double digits (see sidebar, here).

Physical therapy (PT) services are among the fastest-growing in terms of Medicare utilization for a variety of reasons (see story, here). Unfortunately, denials have gone up just as quickly, according to an NPP Report analysis.

NPP Benchmark: This chart shows Medicare denial rates for the six major non-physician practitioner (NPP) specialties from 2005 to 2007. Denial rates were calculated by comparing the number of denied services to the total number billed to Medicare; submissions for all codes were included.

The HHS Office of Inspector General (OIG) has told CMS to get tough on incident-to services billed by you and your peers, according to an Aug. 6 OIG report. Expect tougher scrutiny of any service billed incident-to as CMS looks to further revise and improve its rules.

Clinical Social Workers (CSWs) who work in Florida are the latest providers targeted by the Recovery Audit Contractors (RACs).

Have more than one locum tenens physicians lined up when you know a provider will be gone for more than 60 days. You can't use the same locum tenens physician beyond 60 continuous days - whether your physician is out for an extended leave of absence or left your practice completely.

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

Q. What needs to be documented in the record when time spent on counseling/coordination of care is the key element of an E/M visit?