Practices that are hospital owned will want to take a close look at the recent expansion of Medicare's "three-day payment window" for hospitals. That's because if your practice comes under Medicare's definition of being "wholly owned or operated" by a hospital, you could find your physicians' services bundled into the hospital inpatient payment if the patient is admitted up to three days after the office visit.

Reports of health care fraud against your practice can lead to a payment suspension, according to a new anti-fraud proposal from CMS. The agency already has the ability to suspend your payments for up to 180 days when it suspects fraud, but now CMS wants to define exactly what constitutes a credible allegation of fraud.

The number of E/M services billed to Medicare increased in 2009 over 2008 levels, reversing a trend of E/M declines that began in 2006, a Part B News analysis of the latest CMS data from 2009 shows. Total E/M utilization increased by 452,832 services, or just 0.19%, in this one-year period.

Not all referred Medicare patients you see will be referred by a doctor enrolled in the Medicare program. That won't stop CMS from denying services you provide to these patients unless the referring provider goes through a new modified enrollment application process.

Look for incentive payments rewarding your practice for participation in 2009 electronic prescribing and Physician Quality Reporting Initiative (PQRI) programs to start arriving in your bank accounts if they haven't already. Several of your peers have reported receiving thousands of dollars in bonus checks for the e-prescribing program during the last week of September.

There are 130 new ICD-9 codes effective Oct. 1 that you and your peers must start using as there is no grace period for implementing these codes. Most of the proposed ICD-9 code changes from April were finalized (PBN 4/26/10), but you will also find a few additions to the list to use this flu season.

When you've already invested in health information technology (HIT), you may not need to buy a complete, brand-new electronic health record (EHR) system to achieve meaningful use and earn federal bonus money. Last week: Experts and vendors explained why "modular" EHR certification can help you save money and minimize staff time spent on learning new systems. This approach lets you buy what you need to meet meaningful use, while keeping HIT components you already have that contribute to meaningful use in some way (PBN 9/20/10).

Unfortunately, it's often up to you and your peers to break the news that the "insurance" card the patient is holding isn't insurance and you don't have a contract with that company. "The doctor will get caught in the middle. It's tough to tell a patient that the patient is not getting anything [for his money]," says Armand Feliciano, associate director of medical and regulatory policy for the California Medical Association in San Diego.

A new Senate proposal would provide CMS with the funds to finally reprocess your claims and account for Medicare Physician Fee Schedule updates made by the health care reform law in March. Senate Finance Committee Chairman Max Baucus (D-Mont.) included $175 million in the Job Creation and Tax Cut Act of 2010 to fund the reprocessing.

You are days away from dealing with the latest round of Correct Coding Initiative (CCI) edits, which are squarely targeted at minor supporting procedures often billed with musculoskeletal, digestive and urinary system surgeries, according to a Part B News analysis. CCI version 16.3 is the last version for 2010 and will take effect Oct. 1.