Don't be surprised when you find that 80% of your Physician Quality Reporting Initiative (PQRI) modifier usage involves 8P (action not performed, reason not otherwise specified). Using the modifier may seem as if you're getting a bonus for not performing the intended quality service - but CMS says there are several instances where use of 8P is appropriate (see story).

Your peers got a lot of mileage out of modifier 8P (action not performed, reason not otherwise specified) last year. It was reported nearly 1.9 million times during the 2008 Physician Quality Reporting Initiative (PQRI), but this won't be raising any auditor eyebrows. Use of the 8P is completely appropriate within PQRI, a CMS official says in an email to Part B News.

Don't expect to see the final list of 2010 Physician Quality Reporting Initiative (PQRI) measures until later this month, but CMS tipped its hand that it expects to apply tighter standards than in previous years.

Don't expect to see interim reports on your Physician Quality Reporting Initiative (PQRI) performance in 2010. CMS says it considered the idea, but could not provide the feedback on time in a secure environment. Most errors are caused by coding mistakes or failing to report on 80% of eligible cases, the agency notes. It will attempt to provide aggregate performance data for all respondents on a quarterly basis.

Your practice must stop billing consult codes on Medicare claims starting Jan. 1. Instead, you'll use the appropriate inpatient or outpatient visit codes. The codes affected are outpatient codes 99241-99245 and inpatient codes 99251-99255.

You're just seven weeks away from a 2010 conversion factor (CF) that's a shocking $7.66 less than the 2009 CF, unless Congress steps in with a pay fix, according to the final 2010 Medicare Physician Fee Schedule (PFS; see Part B News Special Report). The conversion factor is slated to drop to $28.4061 from $36.0666 on Jan. 1, though experts and Washington insiders believe a pay-fix is inevitable (PBN 11/2/09).

There are lots of little details contained in the 2010 Medicare Physician Fee Schedule (PFS) that you need to know about to be prepared to bill correctly and project your reimbursements for 2010.

You and your peers flocked to perioperative, health information technology (HIT) and diabetes measures to earn incentive bonuses from the Physician Quality Reporting Initiative (PQRI) in 2008, according to a Part B News analysis of CMS billing data.

Expect implementation of the Red Flag Rules to move forward on Nov. 1 without further delay. The Federal Trade Commission (FTC) had delayed the rules for a year to provide more education to the various businesses affected - including your practice.

You're not likely to actually suffer a 21.5% cut to your Medicare payments on Jan. 1, 2010, despite the recent failure of a pay-fix bill to pass the Senate. Instead, expect a one or two-year fix to increase your payments by a small amount, experts say.