You will have an easier time enrolling your providers in Medicare or updating their enrollment information thanks to recent improvements to CMS’s Internet-based Provider Enrollment Chain Ownership System (PECOS). The online PECOS system is supposed to process enrollment changes and applications more quickly than the longstanding method of filling out and mailing paper forms, the agency says.

With dwindling payments from private payers and flat Medicare payments, the looming transition to ICD-10 and the increased focus on improper billing, it’s more important than ever to bill and collect properly and quickly. But if you outsource your billing to an independent billing company, you need to know the difference between a mediocre billing company and a really great one to ensure you’re getting value.

Your physicians may certify a patient for hospice care up to 15 days prior to the patient electing hospice treatment, CMS clarifies in transmittal 2171 to the Medicare Claims Processing Manual. Each recertification for additional hospice care may also be done up to 15 days before those periods begin.

You would get a 1% increase to Medicare physician payments starting Jan. 1, 2012, if the Medicare Payment Advisory Commission (MedPAC) actually had the power to turn its recommendations into law. MedPAC, a Washington-based advisory panel which Congress depends on for research and suggestions, recommended weak reimbursement increases all around in its formal 2011 report to Congress.

Medicare’s annual wellness visits (AWVs) have generated Capitol Hill acclaim and almost $25 million in CMS payments to private practices and outpatient facilities for the new benefit, according to participation numbers released in a Congressional hearing March 15. Its success could mean a revenue boost for your practice.

It's looking like federal measures targeting the rapid growth and cost of advanced imaging services have taken a toll. The impact comes in the form a payment decrease that is not seen by simple imaging services. These charts examine the utilization and payment trends for simple (X-rays, ultrasounds, echoes) and advanced imaging services (CT, MRI, PET, nuclear) from 2005 and 2009.

How do we correctly bill the non-covered preventive visit (typically 99397) with the carve-out of covered services (99213, G0101, Q0091) when the patient has a secondary insurance? Do we do the carve-out before we bill the secondary insurance or after we bill the secondary, then bill the patient what is left?

Your eligibility for the new Primary Care Incentive Payment (PCIP) program will be determined based on claims data from 2009 – or 2010 for providers not established in 2009 – but how much bonus money you get will be based on how many primary care services you bill in the actual year represented by the bonus checks, CMS says.

Your practice will soon have one more good reason to make sure you get the patient to sign an advance beneficiary notice (ABN) if you think a claim doesn’t meet your carrier’s medical necessity requirements. Starting July 1, CMS has given its contractors discretion to auto-deny claims that arrive with the GZ modifier, which indicates that the claim may not meet medical necessity rules and that the patient did not sign an ABN.

Your biggest long-term worry – that your Medicare payments are perpetually balanced on a razor’s edge, at the annual mercy of the mood in Congress – is shared by the Medicare Payment Advisory Commission (MedPAC), which spent its latest meeting discussing ways to end this problem.