You could be staring at more denials for lack of medical necessity and costly repayments if you don't strengthen your documentation to meet stringent new requirements in the review criteria used in Medicare's latest Comprehensive Error Rate Test (CERT) program.

You would see another temporary reprieve from a 21% Medicare pay cut - this time for seven months - under a provision Senate lawmakers tucked into a jobs-creation bill. The move would push back to Oct. 1 a pay cut now set for March 1.  

You won't have to worry about major changes to the definition of "place of service" and "date of service" for the interpretation of diagnostic services anymore, Part B News has learned. CMS has decided to postpone the rule, which would've affected any physician performing the professional component (PC) of diagnostic tests in general and radiologists in particular.

CMS will address lingering consultation billing issues - such as what to bill when an inpatient consult service does not rise to the level of an initial hospital care code - in new guidance "soon," officials say.

Q. We understand we can't collect both the e-prescribing (e-Rx) and the electronic health records (EHR) incentive payments as that is considered double dipping. We'd like to know if we could report the PQRI measures and take part in either the e-prescribing or EHR incentive programs.

Summary: You and your peers are increasingly confident in billing higher-level E/M codes, according to a Part B News analysis of the latest CMS claims data. This chart shows the percentage utilization codes 99214 and 99215 out of all utilization in the 99211-92215 code series from 2006 to 2008.

Correction: A Jan. 25 story on Recovery Audit Contractor (RAC) targets should have stated Connolly Healthcare is only approved to review outpatient hospital claims billing J0152 (Adenosine injection, $80.92). The original story had mentioned J0150 (injection adenosine, 6 mg, $10.20), but CMS has since clarified the RAC will only target J0152.

CMS has named the three national accreditation organizations that will accredit providers of advanced imaging services, the agency said in a Jan. 28 news release.

You will receive a denial for an E/M service when it is billed on the same day the patient receives the "Welcome to Medicare" visit unless you attach modifier 25 (significant, separately identifiable E/M service) to the E/M code.

You now have an easy way of finding out whether your providers will face numerous claim rejections after April 5, when CMS will begin cracking down on claims submitted by ordering/referring providers who aren't enrolled or up-to-date in its online Provider Enrollment Chain Ownership System (PECOS). Remember: It's not just your providers who must be enrolled and updated. Any providers sending you orders and/or referrals must be as well, or you'll get claims rejections (PBN 12/14/09).