This chart shows the regions with the highest Medicare denial rates in 2007 and compares it with their 2006 rates. The regions are geographic practice cost index (GPCI) locations; GPCIs that billed less than 1 million claims annually were excluded from analysis. The percentage figures above the bars indicate the percent change in denial rates from 2006 to 2007. The overall trend is alarming: 80% of these GPCI regions, which already had high denial rates in 2006, saw increased denials in 2007.

Attached to your e-mailed version of Part B News is a diagnostic testing request form created by Sean Weiss CPC of DecisionHealth Professional Services. Use this form to provide medically necessary reasons that support diagnostic testing interpretations performed by your practice. 

Congress should give you and your peers a 1.1% payment update instead of the 21% pay cut, according to the latest report from the Medicare Payment Advisory Commission (MedPAC). In its March report to Congress, MedPAC also recommends that all medical drug, device and supply manufacturers be required to disclose their financial relationships with physicians and hospitals.

CMS is looking at revising its online Medicare enrollment policy to allow providers to share their username and password with a representative or proxy, Part B News has learned. This change would allow the provider to delegate completion of enrollment applications to a third party, such as an enrollment or credentialing manager. CMS would still caution providers to "be very careful about sharing this information because the provider will continue to be held accountable for any errors or misuse of this information," an agency official says.

Q. A referring provider for whom we did a consult maintains that since he only does elective procedures, he is not required to have a National Provider Identifier (NPI). If he's not required to have an NPI, can we bill Medicare for the consult? What would I put in the referring physician field?

Providers must have their Tax Identification Number (TIN) handy to identify themselves when calling their Medicare Administrative Contractors (MACs) with a problem or inquiry.

President Obama nominated Kansas Gov. Kathleen Sebelius to be the next HHS secretary on March 2.

Denials for wound care services (11040-11044) cost you and your peers more than $40 million in 2007, according to the latest available CMS claims data.

This chart shows utilization growth by region - based on geographic practice cost index (GPCI) locations - from 2006 to 2007.

You shouldn't see improper denials much longer for the 20 PQRI tracking codes we told you about last week (PBN 3/2/09). Corrections to the status indicators for those codes top the list of April fee schedule changes detailed by CMS in transmittal 1691 to the Medicare Claims Processing Manual.