Summary: Overall denial rates by state don't vary significantly (the range is from 8% to 14%, with an average of 11.4%), but the number of denials per single Medicare beneficiary do, a Part B News analysis shows. This chart compares the five states with the greatest number of denials for their enrolled population of beneficiaries to the five with the least. TIP: You'll find a chart listing the DPB for every state in this article, as a Part B News online extra.

You're now able to formally file your claim for a share of class action settlement proceeds if you saw patients who were members of UnitedHealth Group or one of its subsidiaries on an out-of-network basis from March 15, 1994 through Nov. 18, 2009. The class action suit involved United's use of its Ingenix data to calculate payments to out-of-network providers.

House and Senate leaders are working on another temporary payment fix to delay a 21.3% cut to your Medicare reimbursements, sources tell Part B News. How long lawmakers will propose to delay the sustainable growth rate (SGR) cut to your payments still remains to be seen. But your Medicare reimbursements will be substantially reduced on June 1 if Congress fails to act by then.

You'll soon see twice the pay hit you're used to when you bill multiple diagnostic imaging services on contiguous body parts, thanks to a provision in the health reform law that CMS is moving quickly to implement. Radiologists are set to suffer the most, though orthopedic practices and cardiologists also bill multiple scans of related body parts with some frequency, experts say.

Your physicians are starting to plan summer vacations, which may force you to bring in temporary replacements and bill under Medicare's confusing locum tenens billing rules. Bringing in temporary physicians under locum tenens - which requires you to bill under the Q6 modifier using the national provider identifier (NPI) of the physician being replaced - often leads to a barrage of questions about hypothetical situations.

You'll be paid slightly less for your services for the remainder of 2010 because CMS reduced the conversion factor used to calculate your payments by half a penny as a result of several updates to the 2010 Medicare Physician Fee Schedule. These updates include practice expense geographic price cost index (PE-GPCI) changes affecting practices in low-cost areas called for in the new health care reform law (PBN 4/12/10).

You now must get your providers' enrollment information fully updated in the Provider Enrollment, Chain, and Ownership System (PECOS) by July 6 to avoid claims rejections when they order or refer services, according to a CMS interim final rule published in the May 5 Federal Register. This requirement was already slated to take effect Jan. 3, 2011 (PBN 2/22/10) but this final rule pushes the date forward to July 6.

You've seen lots of stories lately, including some in Part B News, on the difficulties of collecting patient payments and Medicare and Medicaid payments. But you also need to keep an eye on how quickly you are getting paid by your private payers.

When your practice constantly refers a large stream of patients to the same type of specialist, it's a good opportunity to see whether you can add that specialty to your group to increase revenue and improve patient access and convenience, experts say. Your first move is to conduct a thorough, data-driven analysis to ensure this makes financial sense for your practice and its circumstances. Use this five-step guide to do it.

Before you decide to add another specialty to your practice, think about the potential fallout that could occur in your community. Physicians themselves advise open communication and negotiation to address any conflicts that arise because of overlapping services.