Summary: Do certain specialties do a lot worse on getting paid for high-level E/M codes? This analysis takes a shot at the question by looking at the difference in the denial rate for level 3 E/M codes and level 5 E/M codes. Remember: Level 3 E/Ms are the single most commonly billed Medicare service, according to years of CMS claims data (PBN 10/12/09). NOTE: These specialties were chosen for having high annual Medicare utilization, and to ensure a diverse range of practices would be represented.

There's still no timeframe for when CMS will reprocess your 2010 claims with fee schedule corrections called for in the Patient Protection and Affordable Care Act (PPACA, PBN 8/9/10). CMS needs to reprocess hundreds of millions of claims, says William Rogers, MD, director of CMS's Physician Regulatory Issues Team (PRIT).

Medical associations strongly oppose CMS's methodology to calculate 2012 penalties you would face for failing to adopt electronic prescribing. CMS plans to use claims filed during the first six months of 2011 to determine if your 2012 claims will be paid at a reduced rate (PBN 7/26/10). You and your peers must report that you e-prescribed at least 10 times in order to avoid a 1% payment decrease, CMS says in the proposed 2011 Medicare Physician Fee Schedule.

You could get an automatic bonus payment worth 10% of your Medicare allowed charges for primary care services next year. CMS outlines the payment in its proposed 2011 Physician Fee Schedule (PFS), and while the rule is proposed, the agency must start the payments next year, under the health reform law. The bonus would be split into quarterly payments, beginning in January. Remember: The 10% isn't 10% of all your Medicare allowed charges.

Get your hands on new documents on compliance with Americans with Disabilities Act (ADA) requirements at your practice from the Department of Justice (DOJ). The guidance will help you fulfill your responsibilities to treat patients with disabilities. Your legal requirement to provide access and comparable treatment to the disabled is not new, but many physicians are not providing adequate access, DOJ officials say.

Start planning now to test your electronic claims for the new HIPAA standard, version 5010. CMS will begin testing practice management systems and other software beginning in January 2011. IMPORTANT: CMS is giving you a full year to test 5010 upgrades starting on Jan. 1, 2011. Failing to test your software with the 5010-compliant upgrades will keep your claims from getting paid in 2012.

Immediately review your observation billing policies. The rapid growth of observation codes by you and your peers is being scrutinized by CMS officials. A Part B News analysis of CMS billing data confirms the surge in observation billing. Example: Usage of 99234-99236 (observation/same hospital date) doubled to 378,954 in 2008 from 181,705 in 2000.