Recent Medicare Payment Advisory Commission (MedPAC) data shows controls to rein in spending are not working, which is why you're now seeing calls in Washington for MedPAC or some other independent agency to set payment rates (PBN 7/27/09).

This week's analysis shows 10 of the fastest-growing codes with high denials from 2007, the most recent year of data available. We determined the growth rate by comparing claims submitted in 2006 and 2007. To maximize the relevance, all codes billed less than 100,000 times annually were excluded from analysis. The results are still highly revealing.

Be prepared to once again have the option to administer drugs supplied by the Competitive Acquisition Program (CAP) in 2010 rather than buy and bill for the drugs yourself, CMS says. CMS hopes to rekindle your interest in CAP by loosening restrictions, according to plans to bring CAP back in the proposed 2010 Medicare Physician Fee Schedule.

These are the seven approved issues posted by Connolly Healthcare (see story, here). NOTE: These services, eligible for a Recovery Audit Contractor (RAC) review, are only aimed at physicians and outpatient hospitals in South Carolina, so far.

Make sure your practice is using modifier 25 correctly when billing an additional E/M service with a procedure. A Part B News analysis of CMS billing data shows denial rates for lower-level E/M codes billed with the modifier are well above 20%. Experts believe you and your peers are appending modifier 25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) with minor procedures such as an injection.

Progress toward a much-anticipated draft health reform bill in the Senate has stalled as public sentiment on reform sours, Part B News has learned. The Senate Finance Committee - a key piece of the puzzle because it has jurisdiction over Medicare payment provisions in the bill - was expected to release its draft legislation with bipartisan support from its members before the Senate recesses Aug. 7 (PBN 8/3/09).

You don't need to spend a ton on a new electronic health record system (EHR) and completely revamp your daily routines to run a more efficient practice. There are less expensive, less complicated alternatives that have been proven in the field to simplify practice administration, experts say. Here are three tools your practice can use to improve its performance.

You've got a new set of rules to follow to get paid for PET scans used to determine an initial treatment strategy for most types of cancer. CMS is adding coverage for some procedures while removing coverage for others; the agency is also creating additional modifiers to aid billing. Transmittal 1772 to the Medicare Claims Processing Manual, released July 17, is intended to differentiate PET scans used to determine an initial treatment strategy from scans used guide all subsequent treatment.

If you already have an electronic health record (EHR) and participate in the Medicare Physician Quality Reporting Initiative (PQRI), reporting may get easier and become a more accurate depiction of actual care next year, as CMS is considering expanding the program to include clinical data reported from EHRs.

Getting a piece of the federal stimulus money for adopting electronic health records (EHRs) may have just gotten a little bit easier. But you are not in the clear yet. The second draft of a definition for "meaningful use" of health IT to qualify for stimulus funding, published in July, proposes to loosen some of the original standards and open up the certification process to some competition.