The $1 trillion health care reform bill impacts the non-physician practitioners (NPPs) at your practice as well as physicians. A NPP will need to participate in the Physician Quality Reporting Initiative (PQRI) by 2015 or see his or her Medicare payments reduced by 1.5%. By 2016, payments will be reduced by 2% when an NPP fails to report PQRI measures. 

This week's question is answered by Sean Weiss, CPC, vice president of DecisionHealth Professional Services.

Q. A follow-up to last week's Ask a Part B News Expert (PBN 4/19/10) - Here's the trickier scenario that comes up: When Dr. A decides to leave his current practice and join Dr. B., one of Dr. A.'s patients decides to follow him to the new practice. A month later the patient has an immediate medical need but her first encounter at the new practice is with Dr. B. Will Dr. B. bill a new or established visit code?

You can get reimbursed for services provided to prison or jail inmates on Medicare under certain circumstances, according to a recent CMS transmittal. CMS uses data from the Social Security Administration to determine when a patient is behind bars. In most cases, Medicare will deny claims for patients in the big house, but here's a few conditions when the program will provide coverage.

Summary: Allergy and oncology services have seen some of the greatest percent growth in denial rates from 2006 to 2008, while psychiatry codes are among the services on the opposite end of the spectrum. NOTE: This chart measures the percent change in the denial rate - itself measured by a percent figure - of the highest-utilization codes from 2006 to 2008. Services billed less than 1 million times annually to Medicare were excluded from analysis, as were all pathology and laboratory test codes.

You're likely to see significant changes to Medicare coverage policies under Donald Berwick, MD, President Obama's choice for his first CMS administrator, known as a longtime advocate for health quality. As CMS administrator, Dr. Berwick, currently a Harvard professor and formerly a practicing pediatrician, will have the power to test different payment systems quickly thanks to a provision in the recently passed health reform law.

There are now six protests against Medicare Administrative Contractors (MACs) spanning six jurisdictions across the country, delaying the transition to MACs in a total of 17 states, Part B News has learned. Every state affected by a MAC transition will see a temporary "blackout period" during which their regional recovery audit contractor (RAC) will not take any enforcement or auditing action.

You have two unpleasant options when billing consults with Medicare as the secondary payer, but by taking a few factors into account before filing the claim, you can ensure you get the highest payment you are entitled to without wasting scarce practice dollars, experts say.

Faxing your patient's prescription to the local pharmacy from a computer won't count toward meeting criteria to earn a bonus under CMS's electronic prescribing initiative. But when you properly transmit an electronic prescription that is converted into a fax prior to being filled, it does count toward earning the bonus, CMS officials say. This scenario is a legitimate e-prescribing transaction by CMS's standards.

Anticipate and prepare for billing with new diagnosis codes for blood type incompatibility, multiple pregnancies, cognitive deficits and extreme obesity that will take effect Oct. 1, 2010. CMS has also proposed a new code to designate patients with a "do not resuscitate status."

Check your remittances for claims with dates of service of April 1 and beyond as at least one carrier processed claims at a reduced rate. The claims will require re-processing. Other Medicare carriers say they held off on processing claims with dates of service of April 1 and beyond until after Congress acted late on April 15 to pass a pay fix, which was quickly signed by President Obama, to delay the 21.3% cut until May 31 (PBN 4/19/10).