Your providers would be given considerable flexibility to bill preventive services graded highly by the U.S. Preventive Services Task Force (USPSTF), but there are a few stumbling blocks you need to be aware of, Part B News has learned.

You'll see your bottom line payments affected by a variety of complicated geographic practice cost index (GPCI) and relative value unit (RVU) changes, assuming the proposed 2011 Physician Fee Schedule (PFS) is finalized. There's actually four separate factors that would affect how your Medicare payments are calculated, making it very difficult to isolate the impact of each one.

The government will eventually pay out $27 billion over the next couple years. How much of that money your practice takes in will depend on when you start meeting meaningful use requirements and whether you qualify for Medicare or Medicaid incentives. Remember: Failing to demonstrate meaningful use by the end of 2014 means your Medicare payments will start to decrease in 2015.

We've reported that CMS has implemented a 2.2% increase to your Medicare payments (PBN 7/12/10). But your payments are set to drastically drop in less than five months and will decrease even more in 2011 unless Congress fixes the Medicare payment formula. This Part B News analysis shows you how much these commonly billed services will decrease after the current payment rate expires on Nov. 30.

This detailed chart shows all 15 core meaningful use requirements, which must be met by providers who want their slice of the $27 billion in electronic health record (EHR) incentives being doled out by Medicare.

Summary: These charts examine how Medicare claims denials are affected by the transition from carriers to the new Medicare administrative contractor (MAC) system, based on the most recent CMS data available. Few MAC transitions were complete by 2008, though MAC jurisdictions 4 and 5 (Texas and Nebraska) were transitioned in early 2008. Claims data from 2006 was chosen as the "starting" data because no MAC transitions anywhere took place until March 2007 (PBN 8/7/06). NOTE: Transitions for J4 and J5 did not end until a few months into 2008, but because CMS claims data cannot be broken down by month, the 2008 denials reflect a combination of mostly post-transition claims and some claims processed by legacy carriers.

This week's question is answered by Regan Bode, CPC, CPC-H, CPMA, CEMC, ACS-EM, content manager for DecisionHealth and consultant for DecisionHealth Professional Services.

Q. Our agency bills based on electronic feeds received from clinics and code selections are defaulted based on patient age and criteria. As an example, a provider doesn't assign a code for an immunization, and the computer generates the code based on the patient's age. A coder does not verify the assigned code. We are now trying to have the physicians themselves code these visits but they are resisting. Are the physicians required to code their own visits?