You're likely to see significant changes to Medicare coverage policies under Donald Berwick, MD, President Obama's choice for his first CMS administrator, known as a longtime advocate for health quality. As CMS administrator, Dr. Berwick, currently a Harvard professor and formerly a practicing pediatrician, will have the power to test different payment systems quickly thanks to a provision in the recently passed health reform law.

There are now six protests against Medicare Administrative Contractors (MACs) spanning six jurisdictions across the country, delaying the transition to MACs in a total of 17 states, Part B News has learned. Every state affected by a MAC transition will see a temporary "blackout period" during which their regional recovery audit contractor (RAC) will not take any enforcement or auditing action.

You have two unpleasant options when billing consults with Medicare as the secondary payer, but by taking a few factors into account before filing the claim, you can ensure you get the highest payment you are entitled to without wasting scarce practice dollars, experts say.

Faxing your patient's prescription to the local pharmacy from a computer won't count toward meeting criteria to earn a bonus under CMS's electronic prescribing initiative. But when you properly transmit an electronic prescription that is converted into a fax prior to being filled, it does count toward earning the bonus, CMS officials say. This scenario is a legitimate e-prescribing transaction by CMS's standards.

Anticipate and prepare for billing with new diagnosis codes for blood type incompatibility, multiple pregnancies, cognitive deficits and extreme obesity that will take effect Oct. 1, 2010. CMS has also proposed a new code to designate patients with a "do not resuscitate status."

Check your remittances for claims with dates of service of April 1 and beyond as at least one carrier processed claims at a reduced rate. The claims will require re-processing. Other Medicare carriers say they held off on processing claims with dates of service of April 1 and beyond until after Congress acted late on April 15 to pass a pay fix, which was quickly signed by President Obama, to delay the 21.3% cut until May 31 (PBN 4/19/10).

Here's the scenario: A physician leaves his old practice and joins another local practice. When the physician sees a former patient from the old practice at the new practice is the patient new or established according to Medicare's rules?

Major metropolitan areas and two island territories saw the highest E/M denial rates in 2008, CMS claims data shows. Six of the top 10 high-denial geographic practice cost indices (GPCIs) are in big cities on the coasts; two are in the West and two are territories. NOTE: E/M denials were measured by compiling denials for all established and new outpatient visits, initial and subsequent hospital visits, and all consultation codes, which are no longer paid by Medicare.

Download this month's tool, a letter to help you explain the sustainable growth rate (SGR) to patients, from the Part B News website, www.partbnews.com. This tool, developed by Part B News, will help you articulate the impact of the SGR on Medicare reimbursements to patients. You are able to customize this tool with your letterhead.

You no longer have up to 15 to 26 months to file Medicare claims, CMS stated in an announcement April 1. The Patient Protection and Affordable Care Act (PPACA) reduced the amount of time to 12 months from the date of service (PBN 3/29/10).