Denial rates for most surgical procedures declined from 2008 to 2009, continuing a trend that began in 2007 (PBN 1/25/10). This chart examines denial rates for 10 surgical procedures that have high Medicare utilization and represent a wide variety of specialties. NOTE: The utilization minimum was 100,000 services billed annually.

We have a physician doing lesion removals and having the patient come back two weeks later to bill for the service. Minor lesion removals have a 10-day global. The patient is coming back after the end of the global window, but it is still suture removal and seems like it should be part of the global. The provider insists on billing, because it is outside of the global time window as it is outside the global. What can I show the provider to prove is not a billable service?

You can now have hope that your claims from the first half of 2010 will be reprocessed and paid at the higher rates you’re entitled to receive within the next few months. The pay increase for some of these services will approach 7%. CMS officials told your peers during a Jan. 11 conference call that it’s closer to finalizing reprocessing plans. 

Your practice and patients stand to benefit now that 30 preventive services no longer require copays to be collected or deductibles to be met in 2011 and beyond. To get the most out of this change – part of the health reform law – spread the word about the free services, ensure patients are current on preventive screenings and plan for caveats when screenings turn up problems, experts say.

Your physician and non-physician providers (NPPs) are getting a reprieve from CMS’s new rule on signatures for clinical lab tests, which would have required a provider signature on every paper order for a test, starting Jan. 1, 2011. NOTE: This is an actual physician signature that can’t be substituted with a rubber stamp or signoff by another staff member, CMS says.

A handful of providers across the country have begun to receive bonus dollars under the federal Electronic Health Record (EHR) Incentive Program, although only those participating in the Medicaid version have been paid, CMS says. Incentive money from the Medicare version of the program will begin to flow in May, an agency official tells Part B News.

Any pediatricians and oral surgeons in your medical group or practice won’t be deactivated because they haven’t billed Medicare for prolonged periods of time, CMS says. CMS excluded these providers from new regulations that force providers out of the Medicare program when they don’t bill Medicare for 12 consecutive months.

You still won’t be reimbursed for providing routine magnetic resonance imaging (MRI) tests – no matter how many precautions and safeguards are taken – to your patients with pacemakers, CMS states in a Dec. 1 proposed decision memo. But CMS left the door open to expanding coverage in future years by allowing a clinical trial for such services