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?

CMS has softened the meaningful use requirements you must meet to earn $44,000 from the electronic health record (EHR) incentive program. The biggest change in the final rule is the reduction of meaningful use requirements you must meet in order to earn incentives. During the first stage of the program, you will need to satisfy 20 of the 25 meaningful use requirements. Fifteen of those standards will be core requirements for the program and you will select five others from a menu of 10 in order to qualify for the bonus.

Your carriers now have marching orders from CMS on how to process claims with the recently passed 2.2% payment increase and reprocess all claims that were paid with a -21.3% rate cut during the month of June. You don't need to take any action to get your claims reprocessed, but you must initiate internal controls at your practice to be sure your claims are paid at the right rate.

You now have an idea of what CMS will expect your practice to do when you offer newly covered annual wellness visits, a major new revenue source made possible by health reform. Assuming the proposed 2011 Physician Fee Schedule stands, the news is good. If a medium-sized primary care practice with 5,000 Medicare patients were to successfully furnish the new service to 90% of Medicare patients in one year, it would earn $779,850. 

You've got a new tool in the race to get your providers properly enrolled in CMS's Provider Enrollment, Chain and Ownership System (PECOS), an agency official announced in a July 7 open door call for home health providers. CMS has posted two lists, one for physicians and one for non-physician practitioners (NPPs), that show all pending PECOS applications currently being processed.