You've probably heard the phrase "patient-centered medical home" before. It's a key part of health care reform legislation because experts say it will improve quality of care and save money (PBN 5/18/09). Implementing a patient-centered medical home will mean changes to how your practice manages patients and the flow of health information. In the next three issues, Part B News will review specific areas - management, process or workflow, and roles and responsibilities - you must address in order to accomplish a successful transition to a medical home environment.

Don't give out your account information in response to a fax you receive that purports to be from your carrier or Medicare Administrative Contractor (MAC). As this issue of Part B News goes to press, we received a warning from CMS that scammers are sending these faxes to physician practices trying to get account information.

Your practice needs to know five key takeaways from CMS's "never events" additions to its Medicare National Coverage Determinations (NCD) Manual. Three relate to a recent transmittal ordering your carrier to deny you payment for never events and two are for when CMS will pay. The agency finalized three NCDs for never events - wrong surgery performed on a patient, a surgery performed on the wrong body part and a surgery on the wrong patient - in January (PBN 2/2/09). You are required to submit claims for these instances, but you won't get paid for the service.

Our carrier's Web site states there must be at least 15 minutes of critical care time spent before we can add another 99292 ($114.69) at the end of the claim. I can't find this documented in CMS' Internet-only Manual (IOM) or a Local Coverage Determination. What should I do?

You're likely to continue having to answer patient questions and concerns regarding the spread of the H1N1 influenza virus, or swine flu. The flu virus strain is showing no sign of slowing down as the World Health Organization (WHO) raised its pandemic alert to the highest level June 11.

Last week we examined Medicare spending growth broken down by broad type-of-service categories such as imaging services and office visits (PBN 6/8/09). This chart gets more specific by looking at spending changes for E/M services. Like last week's Benchmark, all data comes from an April 2009 report by the AMA called "Estimated change in SGR spending from 2007 to 2008."

You wouldn't see the 21% cut to your Medicare payments set to take effect Jan. 1 under a House of Representatives health care reform bill that eliminates the "flawed Sustainable Growth Rate (SGR) formula." The bill, released June 9, came out of the House Ways and Means, Energy and Commerce and Education and Labor committees, who promised to pass major health care reform by August. The Tri-Committee Health Reform proposal would replace the SGR formula used to calculate Medicare payments.

You will need to check with your carrier's local coverage determinations (LCDs) for coverage instructions regarding four inhaler drug codes. The July 2009 update to the physician fee schedule includes this change and introduces three new Q codes.

Here are important dates to help you plan for the 5010 HIPAA standard switch (see story, pg. XXXXX). Keep these dates in mind when speaking to your software vendors about obtaining upgrades for your claims processing system.

Medicare won't pay for patient assessment and management services done by phone, but you're free to bill patients - and many practices are starting to, Part B News has learned. One pain management practice is beginning to bill patients for phone services using non-covered codes because of the rising costs. "A physician can only afford to pay his staff so much for their time, and yes, patients will keep you on the phone for a long time," says Cindy Rhyne, practice administrator for Douglas D. Pritchard MD, a small pain management practice in Statesville, N.C.