Download this month's tool - an Annual Wellness Visit Encounter Form brought to you by DecisionHealth Professional Services - to help you efficiently provide Medicare's new annual wellness visit service. 

Denials cost practices more money in 2009 than 2008, and specialties that perform high-value procedures top this chart of dollar losses per provider. This data shows the 10 specialties that saw the greatest per-provider dollar losses to denials in 2009 and compares their losses to 2008.

I read your Oct. 25 story on the new observation codes for 2011 (PBN 10/25/10). The new codes 99224-99226 are said to be used as  subsequent observation care between 99218-99220 (which to me makes sense) and codes 99221-99223 which are inpatient codes (this doesn't make sense to me). Why wouldn't we continue to use 99231-99233 for subsequent inpatient hospital care?

CMS will ask you to collect more money upfront from your Medicare patients in 2011. The Part B deductible will be $162 next year, a 4.5% increase from the current rate of $155. TIP: Remind your patients when scheduling appointments to be ready to pay the $162 deductible after Jan. 1. Several of your peers reported difficulties collecting the amount earlier this year after the deductible had jumped nearly 15% (PBN 2/1/10).

Your non-physician practitioners (NPPs) have an opportunity to boost revenue significantly thanks to provisions in the final 2011 Physician Fee Schedule (PFS) aimed at strengthening primary care services for seniors, an NPP Report analysis shows.

The 2011 Medicare Physician Fee Schedule had one silver lining for therapy providers. The Multiple Procedure Payment Reduction (MPPR) will slash the practice expense (PE) of subsequent therapy services billed on the same day by 25% instead of the proposed 50% (PBN 11/08/10).

The top two non-physician practitioner (NPP) specialties have similar denial rates for the services they bill most frequently, an NPP Report analysis shows. Nurse practitioners (NPs) and physician assistants (PAs) had almost the same average denial rate for their top codes in 2008, but while NPs lowered their denial rate in 2009, PAs saw their average denial rate increase.

This week's question is answered by Regan Bode, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services.

Q. A doctor provides medical services to a new patient in the hospital, but the patient needs to be seen in the doctor's office after being discharged. Can the doctor charge the office visit as a new patient or is it an established patient visit since the doctor saw him in the hospital for the first time?

Summary: Inpatient denial rates seem to differ most based on whether the place of service (POS) is the inpatient hospital (POS 21) or the emergency room (POS 23). This chart shows how specialty-specific denial rates compare to the average or baseline denial rates for the inpatient hospital and hospital emergency room settings in 2008 and 2009. The five specialties with the greatest positive and negative deviations from the baseline denial rate in a given POS were chosen.

Don't be fooled when you see CMS and other medical societies stating the sustainable growth rate (SGR) will drop Medicare payments by 25% in 2011. The real number is a 30.78% decrease (PBN 11/8/10). The 2011 SGR cut, coupled with delayed cuts from previous years and other payment factors, will drop the 2011 conversion factor used to calculate your Medicare payments to $25.5217, CMS confirmed with Part B News on Nov. 8.