CMS will give Congress three extra days to pass a payment fix before processing claims with a 21.3% cut, an agency official announced. Your contractors will now hold claims submitted for the month of June through Thursday, June 17. CMS will lift the hold on June 18. Claims with a date of service before June 1 will continue to be processed without the cut.

You now have a clear road to payment for every hour of pulmonary rehabilitation performed, a change long sought by specialists and previously covered only by some Medicare contractors under varying local coverage determinations (LCDs). But pulmonary rehabilitation (PR), like its sister services cardiac and intensive cardiac rehabilitation (CR and ICR), isn't just a free new billing opportunity, experts say.

Summary: Different specialties often see certain types of services dominate their billing, such as primary care with E/M codes and radiology with imaging tests. This trend is supported in most cases by the data, though there are a few mild discrepancies where greater utilization doesn't result in particularly low denial rate and vice versa, where specialties with low or moderate utilization don't have very high denial rates.

This week's question is answered by Sean M. Weiss, CCP-P, ACS-EM, CPC, CPC-P CCA-P, vice president and chief compliance officer of DecisionHealth.

Q.  Our lab has a certificate of waiver but Medicare has rejected our use of 87081 (culture screen only) when the doctor collects a culture specimen and uses a culture plate to grow it out. The remittance advice says we are not approved to use this code. How do we get approved or is there another code we should use instead?

You and your patients stand to benefit from complete Medicare coverage of more than 30 preventive services that received recommendation grades of ‘A' or ‘B' from the U.S. Preventive Services Task Force (USPSTF). Thanks to a provision in the health reform law, Medicare will be covering these services without requiring shared payment of any kind from patients, which means you won't need to collect copays or worry about billing patients who haven't yet met their Medicare deductible.

Prepare now to take advantage of a new covered service poised to deliver a significant revenue boost to your practice in 2011 - a fully covered annual wellness visit for all Medicare patients with a waived copay and deductible. This new billing opportunity comes thanks to a provision in the health reform law. A fictional five-provider primary care practice with 5,000 Medicare patients could gain as much as $450,000 a year for providing the service to all eligible patients.

Last week, we told you in Part B News that a new conversion factor will lower payments for some Medicare physicians, but increases to work and practice expense geographic practice costs index (GPCI) values have raised payments for other physicians. But we also mentioned CMS adjusted relative value units (RVUs), which in some cases will cost you and your peers millions of dollars in lost revenue this year.

Your Medicare reimbursements are set to drop 21.3% on Monday, June 14, for all services done on or after June 1, unless the Senate approves a temporary payment fix before that date - and time is running short. The Senate had yet to proceed with a final vote on a House-approved, 19-month pay fix as of June 10. The Senate had proposed and voted on amendments to the bill, none of which would modify the Medicare reimbursement provision. The earliest the Senate could vote on the bill is June 15.

A doctor performs a consult in the office. Three months later the patient is admitted to the hospital and a second doctor asks for a consult. Can the consulting doctor bill another consult or should he bill a subsequent care code since the patient is established? I'd like to know the answer for both Medicare and private payers.

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