Medicare providers not in CMS's Provider Enrollment Chain and Ownership System (PECOS) will become a target for enrollment revalidation in 2010, according to a recent agency transmittal. Act promptly when you get a revalidation request - otherwise you will lose your billing privileges.

There's no clear path to a Medicare pay fix now that a proposal to delay the devastating 21% cut for seven months was removed from the Senate jobs bill a day after its official introduction. You're now just days away from the drastic reduction in payment rates going through.

The highest denial rates for E/M codes are found in a few select hotspots around the country, according to a Part B News analysis of the latest available CMS claims data. These 10 geographic practice cost index (GPCI) locations had the highest denial rates in 2008 and most were also among the top 10 in 2006.

We're one year into the Obama administration and there is still no CMS administrator nominated, confirmed and sworn-in to office. However, CMS is moving to restructure internal management of departments that create and implement Medicare regulations.

This week's question is answered by Margie Scalley Vaught, CPC, coding content specialist for DecisionHealth.

Q. Doctors from our family practice rotate coverage of inpatients with doctors from another family practice on weekends. However, the attending physician always bills for the visit. Everyone feels that it all comes out about even over the year. We have been told we can no longer bill like this. If this is true, what is the proper way to bill for these visits?

Comprehensive Error Rate Test (CERT) audits show it's not just physicians who are responsible for the error rate from more doubling from 2008 to 2009. Non-physician practitioners (NPPs) played a role in the 7.8% fee-for-service error rate, too. 

A non-physician practitioner (NPP) can be a better hire than a physician when you need flexibility and your state laws don't limit their scope of practice, experts say. Once you pass this test, the benefits of picking an NPP over a physician become more obvious, she says. Here are four reasons to go the mid-level route. 

Non-physician practitioners (NPPs) billed far fewer high-level E/M visits than physicians did from 2006 to 2008. The trend affected both new and established patient visits, according to an NPP Report analysis of CMS claims data. Not surprisingly, utilization for established visits is consistently higher than for new visits, which pay better but have more demanding documentation requirements.

This week's question is answered by Margie Scalley Vaught, CPC, coding content specialist for DecisionHealth.  

Q. My doctors want to know when our nurse practitioner can bill a consult. We know Medicare no longer covers consults (99241-99245), but we'd like to know how to bill her consults to our private payers. 

Several physicians of the same specialty work under an "umbrella." All of the physicians in the practice do their own billing and have separate tax ID numbers (TINs). One physician sees a patient in the office. Four months later a different physician sees the same patient and creates a new chart for the patient. In such a scenario, should the second physician bill a new patient visit (99201-99205) or an established patient visit (99211-99215)?