A new addition to a series of claim adjustment reason codes (CARCs) will save you the time and trouble of writing a letter or calling your carrier for clarification. Next April, you'll start to see certain CARCs with the phrase "Note: Refer to the 835 Healthcare Policy Identification Segment, if present" on electronic remittance advices (see chart in full story). The language means you will be able to see a number in the healthcare policy identification segment that you can then use to find the policy on the payer's website once the new 5010 standard is implemented for HIPAA-compliant electronic transfers of claims data.

This week's question is answered by John Burns, CPC, senior consultant for DecisionHealth Professional Services.

Q.  One of our NPs currently provides consults for other providers in our practice. Now that Medicare is cutting consults, how will she bill these patients: New or established?

Great news: Your non-physician practitioners (NPPs) will most likely see payment increases across the board in the next four years, assuming Congress stops the 21.2% pay cut (PBN 11/12/09). This chart shows how payments for 10 services commonly billed by NPPs (at least 1.5 million claims annually) will look over the next four years, starting with current data and using the current conversion factor (CF) to calculate the payments.

Your bread-and-butter audiology codes are at the edge of a payment cliff - and they'll be pushed off starting Jan. 1, 2010, thanks to changes in the final 2010 Medicare Physician Fee Schedule (PFS).

CMS significantly increased the proposed payment for kidney disease education services to patients with stage IV chronic kidney disease (CKD) starting Jan. 1. You'll report either kidney disease education codes G0420 for an individual session or G0421 for a group session. G0420 and G0421 will pay about $108 and $25.60, respectively.

Q. What sort of documentation do we need to support the use of modifier 22 (unusual procedure)? We're not sure how much more work it takes to make the procedure unusual.

Good news if you bill Medicare for Avastin for off-label treatment of age-related macular degeneration (AMD): The massive price cut that went into effect Oct. 1 is no more.

It looked like any other fax, but the message was chilling - a small practice in the Northeast was being told that in two days, a pair of auditors would show up in person to collect 30 patient medical records and other business records deemed necessary to begin a probe audit of the practice.

You had more success earning a bonus during the 2008 Physician Quality Reporting Initiative (PQRI) than in 2007. However, there were measures that gave you and your peers more trouble than others. The measures in this benchmark were all reported more than 100,000 times in 2008, according to CMS's Quality-Data Code Submission Error Report.

CMS doled out $92 million in bonus payments to 85,000 of your peers - and perhaps you, too - for successfully completing the Physician Quality Reporting Initiative (PQRI) in 2008. Providers received an average of roughly $1,000, up from about $600 per provider for the six-month reporting period in 2007.