You and your peers providing consultations in an office setting will face drastic decreases in payment for providing the same service in 2010, according to a Part B News analysis. CMS has used a similar crosswalk to calculate budget neutrality in the Medicare Physician Fee Schedule. Below, we've taken the crosswalk and added dollar amounts to the services - including projections for 2010 payments with and without the scheduled 21.2% cut set for Jan. 1. You'll see dramatic differences between payments you received for a consult performed in 2009 and what you'd receive for performing the same service in 2010. CMS notes its crosswalk is not meant to be used as "billing guidance."

I need help billing a surgery with modifier 50 (bilateral procedure). When I bill a bilateral procedure should I put the code on two lines (once on its own and once with modifier 50) or do I just list the code once with the modifier? I've received conflicting information and would like to get this straight.

CMS is keeping telehealth consultation billing in 2010, according to the final Medicare Physician Fee Schedule. The agency has created these three telehealth codes for inpatient consultations to utilize in your practice.

You can thank members of Congress for the latest last-minute Red Flag Rules reprieve, according to an Oct. 30 press release from the Federal Trade Commission (FTC). Enforcement of the rules has been pushed back to June 1, 2010.

Institutional providers will need to be much more careful in using Medicare's Advance Beneficiary Notice of Non-coverage (ABN) form in 2010, thanks to a tough new rule CMS recently unveiled. Transmittal 1840 to the Medicare Claims Processing Manual, released Oct. 29, isn't explicitly clear about whether it applies to hospitals/facilities or physician practices, but CMS does intend for it to affect only institutional claims (i.e. services done in hospitals and facilities), an agency official confirms in an interview with Part B News.

Don't be surprised when you find that 80% of your Physician Quality Reporting Initiative (PQRI) modifier usage involves 8P (action not performed, reason not otherwise specified). Using the modifier may seem as if you're getting a bonus for not performing the intended quality service - but CMS says there are several instances where use of 8P is appropriate (see story).

Your peers got a lot of mileage out of modifier 8P (action not performed, reason not otherwise specified) last year. It was reported nearly 1.9 million times during the 2008 Physician Quality Reporting Initiative (PQRI), but this won't be raising any auditor eyebrows. Use of the 8P is completely appropriate within PQRI, a CMS official says in an email to Part B News.

Don't expect to see the final list of 2010 Physician Quality Reporting Initiative (PQRI) measures until later this month, but CMS tipped its hand that it expects to apply tighter standards than in previous years.

Don't expect to see interim reports on your Physician Quality Reporting Initiative (PQRI) performance in 2010. CMS says it considered the idea, but could not provide the feedback on time in a secure environment. Most errors are caused by coding mistakes or failing to report on 80% of eligible cases, the agency notes. It will attempt to provide aggregate performance data for all respondents on a quarterly basis.