Summary: Inpatient denial rates seem to differ most based on whether the place of service (POS) is the inpatient hospital (POS 21) or the emergency room (POS 23). This chart shows how specialty-specific denial rates compare to the average or baseline denial rates for the inpatient hospital and hospital emergency room settings in 2008 and 2009. The five specialties with the greatest positive and negative deviations from the baseline denial rate in a given POS were chosen.

Don't be fooled when you see CMS and other medical societies stating the sustainable growth rate (SGR) will drop Medicare payments by 25% in 2011. The real number is a 30.78% decrease (PBN 11/8/10). The 2011 SGR cut, coupled with delayed cuts from previous years and other payment factors, will drop the 2011 conversion factor used to calculate your Medicare payments to $25.5217, CMS confirmed with Part B News on Nov. 8.

Practice expense (PE) and malpractice relative value unit (RVU) updates will increase the total RVUs for high-utilization services that you and your peers bill in 2011, a Part B News analysis of the 2011 Medicare Physician Fee Schedule shows. The increases helped soften projected Medicare payment cuts, but are not enough to prevent decreases across the board.

The Republican wave of Congressmen who won seats on Election Day added new health care professionals to lawmaker ranks. You may want to seek them out when lobbying for health care issues, such as the Medicare reimbursement issues. There will be three physicians in the Senate and 16 in the House starting in January - all Republicans except one. 

Your chances of seeing an automatic bonus payment worth 10% of your Medicare allowed charges for primary care services in 2011 have nearly doubled, thanks to major changes made by CMS in its final 2011 Physician Fee Schedule (PFS).

You still have time to enroll your physicians and other providers in its Provider Enrollment Chain and Ownership System (PECOS) before the ordering/referring deadline on Jan. 3. However, you may end up getting even more time in 2011. CMS has not yet decided when it will turn on claims processing edits that will make sure the ordering/referring provider listed on a claim is in PECOS.

Democrats and Republicans are united in wanting to pass a temporary pay fix before your payments take a 23% nosedive Dec. 1. Neither side was willing to offer specifics such as how long the fix would last or when it would pass, but agreed the election rout of the Democrats doesn't change the need to fix your payments. But in separate interviews with Part B News, members of each party shared sharply opposite views on the idea of repealing the health reform law.

You must use your claims to report at least 10 eligible electronic prescribing (e-prescribing) encounters during the first six months of 2011 or your payments will be reduced by 1% in 2012. Claims-based reporting is the only method you can choose to report G8553 and prevent the 2012 penalty. You can still use other reporting methods, but those options won't keep CMS from lowering your payments.