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Denial rates for most of Medicare's top-billed codes have fallen despite all of them being billed more often year after year for nearly a decade, a comprehensive Part B News analysis shows. However, there are a few notable exceptions where denials have worsened.

Once you know you have providers without updated information in the Provider Enrollment Chain Ownership System (PECOS), you must move quickly to get them in by July 6. After that date, CMS is supposed to begin rejecting claims for services ordered/referred by providers not in PECOS. Use these four tips to get your enrollment application processed without delay.

Palmetto GBA will transition to serve as Medicare Administrative Contractor (MAC) Jurisdiction 11, comprised of North Carolina, South Carolina, Virginia and West Virginia, the carrier has confirmed with Part B News.

Thanks to members of Congress, you need not worry about enforcement of the Red Flag Rules on June 1. In a May 28 press release, the Federal Trade Commission (FTC) announced it would delay enforcement until Dec. 31, 2010. But be warned: Enforcement could still start before the end of the year.

You've heard a lot by now about how the historic Patient Protection and Affordable Care Act (PPACA) will revolutionize health care for consumers, employers and others. What has received little attention, however, is how the new law will alter your dealings with private payers.

Your best bet to avoid costly claim rejections is to ensure that all your providers are up-to-date in CMS's Provider Enrollment Chain Ownership System (PECOS) by July 6, agency officials say. You also need to confirm the PECOS status of providers who refer patients to you or order any covered item or test prior to July 6; you won't be paid for these if they're not in PECOS.

CMS ordered carriers to delay processing your claims with the 21.3% sustainable growth rate (SGR) cut for the first 10 business days of June after Congress failed to delay the decrease before leaving for its Memorial Day break.

You can be sure that your payments will be different for claims processed after June 1 thanks to fee schedule tweaks mandated by health reform and implemented by CMS. Expect a payment increase when you practice in a rural area, but a decrease if you operate in an urban setting due to a minor dip in the conversion factor to $36.0791, a Part B News analysis shows.