As if the conversion factor for 2010 wasn't bad enough, now you can expect your payments to go down even more than you thought last month - unless Congress takes action. CMS adjusted the 2010 conversion factor downward, again, after correcting the relative value units (RVUs) for 14 codes. The conversion factor will be $28.3895 instead of $28.4061, representing just a fraction of a percent difference.

You have not yet seen any private payers follow Medicare's lead and eliminate consultation billing. However, there are private payer issues you need to address before Jan. 1 because you can no longer bill Medicare for consults after that date (PBN 11/9/09). 

The more you know about the way your patients pay their bills - or don't - the better you are at making tough billing decisions, experts say. Record key payment metrics for every patient who walks through the door, such as how many bills were paid on time, how many late payments have been made, and what type of insurance plan each patient has (see sidebar for a full list).

Tracking which patients pay you - and how much effort it takes to get those payments - is a great way to make educated collection efforts (see story). But what exact information should you be looking for and record?

Append modifier KX (requirements specified in the medical policy have been met) to services you know will be denied because the patient's gender conflicts with the service provided. KX is a modifier you'd use to identify services provided to transgender, ambiguous genitalia and hermaphrodite patients, CMS states in Transmittal 1839 to the Medicare Claims Processing Manual.

Government auditors have employed a new method to examine your claims with "heightened scrutiny." As a result, the error rate for Medicare fee-for-service (FFS) claims almost doubled from 2008 to 2009. CMS will release its Comprehensive Error Rate Test (CERT) in a few weeks, a CMS official tells Part B News. The agency says the 2009 FFS error rate will be 7.8%, which amounts to $24.1 billion in improper payments. This will be the first CERT since the 2008 mid-year report (PBN 5/25/09).

Here's my scenario: The patient had a lumpectomy and returned to the office during the 90-day global period. She had a seroma, which the surgeon aspirated. Can I bill for the procedure using modifier 58 (indicates a staged or related procedure or service by the same physician during the postoperative period)?

You're getting three additional months to enroll providers who order supplies or durable medical equipment (DME) into CMS's online enrollment system, Part B News has learned. CMS had recently issued a tough new rule requiring all providers who order supplies or DME be in its online Provider Enrollment Chain Ownership System (PECOS) or face instant denials on their DME claims starting Jan. 1, 2010 (PBN 10/26/09). Providers who refer patients to other Medicare providers or suppliers are also affected by this rule.

Whether you're using the wrong modifier or failing to use the right one, modifier errors are a common reason for denials, with modifiers 25 and 59 being two of the biggest troublemakers (PBN 3/31/08). This chart shows 10 modifiers commonly used by physicians and their denial rates from 2005 to 2008.