Here are the basic elements of the "Welcome to Medicare" exam. Providers who currently render the exam say they've developed checklists and guides to help document the exam. Below, you'll find links to guides to help you complete the exam.

Pay no mind to rumors CMS will delay or even cancel its plan to eliminate consults. Not only is the change permanent, but CMS says it is days away from releasing the new modifier that will become necessary once consults are replaced with E/M visit codes.

You could face a stream of denials even if your enrollment information is fully updated in CMS's online Provider Enrollment Chain Ownership System (PECOS). All it takes is a referral for an item or service - any service, including lab tests or even office visits - that comes from another provider whose information isn't up-to-date in PECOS.

You finally have a clearer definition from the AMA for when an encounter should be a transfer of care vs. a consult, but the policy proved to be too late as far as CMS was concerned when it eliminated consultation billing.

The AMA recently met with top CMS brass to request it delay its new consultations billing policy by a year, stating the changes will cause several billing problems. Specialty societies are also applying pressure. But CMS officials tell Part B News the agency has no plans to delay the consult change now set for implementation Jan. 1.

As if the conversion factor for 2010 wasn't bad enough, now you can expect your payments to go down even more than you thought last month - unless Congress takes action. CMS adjusted the 2010 conversion factor downward, again, after correcting the relative value units (RVUs) for 14 codes. The conversion factor will be $28.3895 instead of $28.4061, representing just a fraction of a percent difference.

You have not yet seen any private payers follow Medicare's lead and eliminate consultation billing. However, there are private payer issues you need to address before Jan. 1 because you can no longer bill Medicare for consults after that date (PBN 11/9/09). 

The more you know about the way your patients pay their bills - or don't - the better you are at making tough billing decisions, experts say. Record key payment metrics for every patient who walks through the door, such as how many bills were paid on time, how many late payments have been made, and what type of insurance plan each patient has (see sidebar for a full list).

Tracking which patients pay you - and how much effort it takes to get those payments - is a great way to make educated collection efforts (see story). But what exact information should you be looking for and record?

Append modifier KX (requirements specified in the medical policy have been met) to services you know will be denied because the patient's gender conflicts with the service provided. KX is a modifier you'd use to identify services provided to transgender, ambiguous genitalia and hermaphrodite patients, CMS states in Transmittal 1839 to the Medicare Claims Processing Manual.