Practices that are hospital owned will want to take a close look at the recent expansion of Medicare's "three-day payment window" for hospitals. That's because if your practice comes under Medicare's definition of being "wholly owned or operated" by a hospital, you could find your physicians' services bundled into the hospital inpatient payment if the patient is admitted up to three days after the office visit.

Reports of health care fraud against your practice can lead to a payment suspension, according to a new anti-fraud proposal from CMS. The agency already has the ability to suspend your payments for up to 180 days when it suspects fraud, but now CMS wants to define exactly what constitutes a credible allegation of fraud.

The number of E/M services billed to Medicare increased in 2009 over 2008 levels, reversing a trend of E/M declines that began in 2006, a Part B News analysis of the latest CMS data from 2009 shows. Total E/M utilization increased by 452,832 services, or just 0.19%, in this one-year period.

Not all referred Medicare patients you see will be referred by a doctor enrolled in the Medicare program. That won't stop CMS from denying services you provide to these patients unless the referring provider goes through a new modified enrollment application process.

Look for incentive payments rewarding your practice for participation in 2009 electronic prescribing and Physician Quality Reporting Initiative (PQRI) programs to start arriving in your bank accounts if they haven't already. Several of your peers have reported receiving thousands of dollars in bonus checks for the e-prescribing program during the last week of September.

There are 130 new ICD-9 codes effective Oct. 1 that you and your peers must start using as there is no grace period for implementing these codes. Most of the proposed ICD-9 code changes from April were finalized (PBN 4/26/10), but you will also find a few additions to the list to use this flu season.

The physician is about to close the door, and the patient blurts out, “I have these chest pains.” 

Take a proactive, organized approach to negotiating contracts and you will do far better than if you just wait to see what the payer offers, says John Schmitt, a managed care expert at EthosPartners Healthcare Management Group, based in Suwanee, GA.

Physicians just don’t want to work in private practice anymore. Or so the prevailing wisdom would have us believe.

Troubling yet predictable findings emerge from the 2010 Review of Physician Recruiting Incentives, the annual survey from physician recruiters Merritt Hawkins/AMN Healthcare, which reflects the market realities of the past year for healthcare in a down economy.