CMS is reassuring you and your peers that you can use split-shared billing for services that would have previously been consultations. Providers were confused over some murky wording in a frequently asked questions (FAQ) document on the elimination of consult codes released in March (PBN 3/8/10). CMS stated, "The split-shared rules applying to E/M services remain in effect, including those cases where services would previously have been reported by CPT consultation codes."

Don't be too quick to stick modifier 59 (distinct procedural service) on claims that include two or more services. Look at other available modifiers to see if they are a better fit, or whether you should be using any modifier at all - that advice comes to you from your carriers and Medicare Administrative Contractors (MACs).

You can now appeal denials resulting from medically unlikely edits (MUEs), which gives you the ability to fight for payments when you can prove that exceeding the edit limit was medically necessary, experts say. CMS reversed previous policy on MUE appeals in Transmittal 652, which took effect April 1. Remember: MUEs are simple edits that only look at units of service performed on the same patient, on the same day, by the same provider.

Several retroactive provisions impacting your Medicare payments in the new health care reform law are proving difficult for CMS to quickly implement. Top CMS officials admitted as much while speaking during a provider conference call on April 13, saying they expect it to take another month or two to set new payment rates for localities that received payment hikes under health reform that are retroactive to Jan. 1.

[Last updated at 9:30 a.m. ET, 4/16/10] President Barack Obama signed an unemployment benefits extension bill late on April 15, which contained a measure postponing the sustainable growth rate (SGR) cut to Medicare reimbursements until May 31. Lawmakers in Washington must enact another pay-fix bill before June 1 or the 21% cut to your Medicare payments will go through. 

This week's question is answered by Sean Weiss, CPC, vice president, DecisionHealth Professional Services.

Q. Is it legal to waive copays for employees who are seen as patients in our office? We want to offer this as a benefit of employment.

Summary: Dermatologists have seen a slight dip in their share of the Medicare utilization pie for the top six most frequently billed dermatology codes. The other top specialties that bill these codes - mainly primary care - have also seen small drops in their share of utilization as well. Non-physician practitioners (NPPs) appear to be making inroads on these services.

Expect stronger versions of many compliance rules you already follow due to health reform, with stricter documentation and disclosure requirements and steeper penalties for violations. Here's a rundown of the four biggest compliance provisions and how they're likely to impact physician practices.

Your chances of having Congress permanently stop the annual Medicare physician pay cuts this year has fallen sharply, insiders and experts say. "If I was a betting man [I would say] no, [a permanent fix is] not going to happen," an industry lobbyist says in an interview with Part B News.

Your paper enrollment applications will see faster action from your carrier or Medicare Administrative Contractor (MAC) under new CMS mandates that take effect June 21. Your carrier will be required to process 90% of paper applications within 90 days of receipt.