Lawmakers in both houses of Congress are moving forward again on crafting a comprehensive health reform bill, but all versions of the legislation include either long-term cuts to Medicare payments or cost-containment measures, Part B News has learned. It's not clear how future cuts would interact with the scheduled 21.5% pay cut for 2010, because the new draft legislation hasn't been released yet.

Your current carrier or Medicare Administrative Contractor (MAC) is almost guaranteed to intensify its own auditing process using the same targets chosen by your recovery audit contractor (RAC) when the permanent program begins, CMS and experts say.

This week's question was answered with the assistance of Margie Scalley Vaught, CPC, Coding Content Specialist for DecisionHealth.  

Q. Can you bill codes 95165 (Antigen therapy prep, $11.54) through 95170 (Antigen therapy prep, $9.02) ‘incident to' if a physician assistant or nurse practitioner prepares the vials of antigens?

High-dollar and high-volume services are guaranteed to top the list of targets recovery audit contractors (RACs) will look for, experts say. That makes physical therapy (PT) a particularly obvious target for RACs once the permanent program goes live sometime this summer.

This chart shows how Medicare payments for ten codes commonly billed by non-physician practitioners (NPPs) will change if the proposed 2010 Physician Fee Schedule is implemented.

A non-physician practitioner (NPP) cannot inject his own opinions or observations when scribing for a physician, or your practice risks violating Medicare's rules for documenting a service.

Few changes in the proposed 2010 Medicare Physician Fee Schedule specifically mention non-physician practitioners (NPPs) - except a stinging pay cut for chiropractors, according to an NPP Report analysis. 

This week's question was answered with the assistance of Margie Scalley Vaught, CPC, Coding Content Specialist for DecisionHealth.

Q. Is a family practice doctor allowed to bill 92250 (fundus photography, $65.28) with a medical necessity diagnosis?

Medicare dollars set aside for treating illegal aliens have been exhausted in ten states, one of which shares a direct border with Mexico.

The ten Physician Quality Reporting Initiative (PQRI) measures listed below had the highest acceptance rates in 2007, according to a CMS report.