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

Q.   Can non-physician practitioners (NPPs) such as physician assistants (PAs) or nurse practitioners (NPs) have reciprocal billing arrangements with one another if all of the PAs/NPs are enrolled in Medicare?

We are getting denials when we bill hemodialysis with a subsequent inpatient visit code with modifier 25. The denials state the service isn't covered when performed during the same session. Can you tell us what we're doing wrong?

Use an attestation statement or signature log to properly identify and authenticate the source of initials or an illegible signature left on a medical record (see story). Here's an example of an attestation statement from CMS.

Most of your peers plan to implement an electronic health records (EHR) system sometime in the next three years, with more practices leaning toward sooner rather than later, according to a Part B News analysis of a recent Medical Group Management Association (MGMA) survey. What's more, a sizeable majority of practices with EHRs - or those in the process of implementing one - expect to qualify for federal incentive dollars by the end of next year.

All specialties bill more E/M codes now that consultation codes have been eliminated. However, the transition from consult codes to E/M codes is likely to have positive and negative effects on specialties depending on what their average denial rates were for E/M services and consult services.

You need fewer mandatory requirements, a simplified certification process for electronic health record (EHR) systems and added eligibility to include providers who do some work in hospital settings to be able to demonstrate meaningful use, physicians and provider groups told CMS in submitted comments on the agency's proposed meaningful use rule.

You and your peers haven't seen many extra denials due to consult elimination, but the process hasn't been trouble-free, according to an unofficial Part B News reader survey. While denials seem to be uncommon, private payer billing issues - particularly when Medicare is also involved as a primary or secondary payer - were a common problem. Here's a look at two key findings from the survey.

More than three months after CMS eliminated consultation codes, you and your peers are most bothered by tricky Medicare-as-secondary payer billing, non-matching code crosswalks and overall lower revenue for specialists, Part B News has learned. While the transition from consults to E/Ms has resulted in relatively few denials (see reader survey results), it's caused an increase in administrative burdens and for specialists, a significant drop in revenue.

Congress may move to adopt another short-term pay fix - widely opposed by medical associations and physician groups - that delays the 21% cut to your payments. On March 17, the House of Representatives approved a bill containing a one-month payment patch carrying current Medicare reimbursement rates until May 1. Your rates are set to drop by 21% on April 1. The bill, the Continuing Extension Act of 2010 (H.R. 4851) now moves on to the Senate.

You must meet CMS's signature requirements today or risk an auditor rejecting your claims and demanding you make costly repayments. The Comprehensive Error Rate Test (CERT) used rigorous criteria to review signatures on medical records in its latest error rate report. As a result, the error rate more than doubled to 7.8% in 2009 (PBN 2/8/10). Medical records - including physician orders and prescriptions - without valid signatures used to support a paid claim will be rejected by CERT auditors and the claim will be denied for lack of medical necessity.