CMS will ask you to collect more money upfront from your Medicare patients in 2011. The Part B deductible will be $162 next year, a 4.5% increase from the current rate of $155. TIP: Remind your patients when scheduling appointments to be ready to pay the $162 deductible after Jan. 1. Several of your peers reported difficulties collecting the amount earlier this year after the deductible had jumped nearly 15% (PBN 2/1/10).

Your non-physician practitioners (NPPs) have an opportunity to boost revenue significantly thanks to provisions in the final 2011 Physician Fee Schedule (PFS) aimed at strengthening primary care services for seniors, an NPP Report analysis shows.

The 2011 Medicare Physician Fee Schedule had one silver lining for therapy providers. The Multiple Procedure Payment Reduction (MPPR) will slash the practice expense (PE) of subsequent therapy services billed on the same day by 25% instead of the proposed 50% (PBN 11/08/10).

The top two non-physician practitioner (NPP) specialties have similar denial rates for the services they bill most frequently, an NPP Report analysis shows. Nurse practitioners (NPs) and physician assistants (PAs) had almost the same average denial rate for their top codes in 2008, but while NPs lowered their denial rate in 2009, PAs saw their average denial rate increase.

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. A doctor provides medical services to a new patient in the hospital, but the patient needs to be seen in the doctor's office after being discharged. Can the doctor charge the office visit as a new patient or is it an established patient visit since the doctor saw him in the hospital for the first time?

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).