Our patient had an emergency appendectomy while she was out of state and now our doctor (the patient's primary care physician) is providing follow-up care during the global period. Can we bill for these services?

You can now get paid by Medicare for providing four types of sleep tests for obstructive sleep apnea, according to a recent CMS national coverage determination (NCD). CMS previously allowed carriers to set coverage rules for the tests (G0398-G0400, PBN 7/28/08).

You would have access to 116 current Physician Quality Reporting Initiative (PQRI) measures, 22 new measures, 26 measures eligible for registry reporting and 10 measures eligible for EHR reporting in 2010 under CMS's proposed fee schedule (see main story).

This is a list of the top 10 challenges facing physician practices, as ranked by physicians responding to a 2009 survey by the Medical Group Management Association (MGMA). More than 2,700 physicians took the survey, which asked them to rate 30 different challenges on a five-point scale, with one being "no challenge" and five being "extremely challenging." The highest score averaged just over four, which means the issue is a "considerable challenge."

You can't completely avoid CMS's recovery audit contractors (RACs) even if your practice goes non-par, agency officials tell Part B News. Any assigned claims you file as a non-par provider are fair game for RACs, says Connie Leonard, RAC project officer in CMS's Office of Financial Management.

The 2010 proposed fee schedule proposes two brand new billing opportunities, but both will include complex requirements for you to follow to get paid. CMS wants to cover intensive cardiac rehabilitation (ICR) and pulmonary rehabilitation (PR) programs, two complex physician services intended to treat chronic diseases by modifying patient lifestyles.

The most recent version of a health reform bill under consideration in the House of Representatives would completely revamp the way Medicare pays you and your peers, Part B News has learned. The bill, called the "America's Affordable Health Choices Act of 2009," was introduced July 14 and contains much more detail on changes to physician payment than its counterpart in the Senate, which was released July 15. The House bill would replace the 21.5% cut scheduled for 2010 with a 1% pay boost as a "transitional update."

You can expect online enrollment to go much faster than using the paper forms, but it has limitations of its own. All providers who have filed an enrollment application since 2004 should be in the PECOS. However, most physicians have been slow to embrace online enrollment as peers report problems and inconsistencies with the system (PBN 4/20/09).

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

Q. Can I unbundle 80050 (general health panel, non-covered): The individual components are 85025 (complete cbc w/auto diff wbc, $11.35), 84443 (assay thyroid stim hormone, $24.53), and 80053 (comprehen metabolic panel, $15.44)? I realize I can't unbundle a covered panel, but need to know if that rule also applies to non-covered panels.

What would you do if your Medicaid checks were replaced by IOU letters from your state? Practices in California are struggling to answer this question after the cash-strapped state issued more than $53 million worth of IOUs, including some to physician practices. If you can wait, however, you may earn an extra few percentage points on the money.