You'll have an easier time appealing when your carrier denies your Medicare enrollment application or suspends your billing privileges, thanks to upcoming CMS rule changes. The agency lays out a slew of provider-friendly changes that offer you more chances to appeal and more information on why your enrollment was shot down or your billing privileges were revoked in Transmittal 316 to the Program Integrity Manual, released Dec. 4. These rule changes will take effect Jan. 4, 2010, CMS says.

Nearly 42,000 changes await you in 2010 under the latest Correct Coding Initiative (CCI) edits released by CMS. That figure is split almost evenly between added and deleted edit pairs, a change from the previous CCI version 15.3 (PBN 9/21/09), which had only 658 deleted pairs, a fraction of the 18,667 deletions in CCI version 16.0, which becomes effective Jan. 1.

Download this month's tool, a Modifier AI decision chart, from the Part B News website, www.partbnews.com. This tool, developed by Part B News' sister publication Medical Practice Compliance Alert, will help you determine when it is appropriate to affix the new modifier AI (principal physician of record) on claims (see story). Print out this handy PDF and give it out to your billing staff to refer to when billing inpatient visits, such as initial inpatient care (99221-99223).

This chart shows the average amount of money 16 common specialties received from Medicare on a per-service basis. The amounts don't include other sources of revenue, such as copays.

Is it proper to bill 46930 (destroy internal hemorrhoids, $189.71) and 46500 (injection into hemorrhoid(s) $180.69) together? In addition, should we submit additional documentation or a modifier to support both services?

Your carriers report that initial and subsequent hospital services billed as split/shared visits are on the rise. An NPP Report analysis of CMS billing data shows the number of initial hospital care (99221-99223) and subsequent hospital care (99231-99233) services is on a downswing (collectively down to 16.4 million times billed in 2008 from 26.5 million in 2000), but carriers say the services being billed as split/shared is increasing.

Starting Jan. 1, your teaching anesthesiologists will get 100% of the Medicare fee schedule payment instead of 50% when working with two residents on overlapping anesthesia cases. The change, long-sought by anesthesiologists, also helps out certified registered nurse anesthetists (CRNAs) by upping their payments in teaching scenarios as well, according to the final 2010 Physician Fee Schedule (PFS).

Most non-physician practitioners (NPPs) will see modest payment increases across the board in 2010, according to an NPP Report analysis of payment projections from the final 2010 Medicare Physician Fee Schedule. NOTE: It's assumed in this chart that Congress stops the 21.4% Medicare physician cut and that the conversion factor remains steady at $36.0666, which seems likely at least in the short term (see PBN story).

Your non-physician practitioners (NPPs) will be affected in the same way as physicians by a tough new CMS rule on provider enrollment, NPP Report has learned. The new rule requires providers who order services and/or supplies, including NPPs, to have all their enrollment information up-to-date in CMS's online Provider Enrollment Chain Ownership System (PECOS) by April 5, 2010.

We're going to offer the Welcome to Medicare visit next year and we planned to have our two NPs perform the services. However, the doctor says we should bill the NPs' work incident-to. Is it possible to bill this service that way?