You can now bill for four previously uncovered cardiac MRI codes that involve blood flow/velocity quantification, Part B News has learned. In Transmittal 1831, released October 16, CMS is stripping off its blanket non-coverage for these procedures, leaving it up to carriers. If your carrier decides to offer coverage, you have a major new billing opportunity that could result in significantly hire payment for the remainder of 2009.

Expect to see a Medicare pay-fix no matter what happens to health reform. But a pay-fix is just the tip of an iceberg of physician-friendly provisions that could become law by year's end, experts say. Here's a breakdown of key reform provisions favoring you and your peers.

CMS struck down a 25-year non-coverage determination for cardiac MRIs that measure blood flow, but your carrier still has the power to deny coverage. Here are four ways to help persuade your carrier to make a positive coverage decision.

You and your peers show greater frustration with carriers over enrollments and appeals when compared to other services such as claims processing. The latest Medicare Contractor Provider Satisfaction Survey details your carrier's strengths and weaknesses - and carriers ranked the worst in the areas of enrollment and appeals. When you know your carrier struggles in a specific area, you may need to spend more time and effort when you engage the carrier in that area.

Don't be surprised when your new provider receives a reminder regarding enrollment from CMS soon after he or she begins providing services. CMS wants providers to close out enrollment at previous employers by using the CMS-855I application, according to Transmittal 307.

Providers heavily utilized these measures when attempting to meet requirements to earn bonus payments from the Physician Quality Reporting Initiative (PQRI) in 2008 (see story, pg. 1), according to a Part B News analysis of CMS billing data for that year.

This week's question is answered by Regan Bode, CPC, senior consultant for DecisionHealth Professional Services.

Q.   Help us settle this dispute. A colleague insists it could be fraud if we don't take and note the patient's vitals at every office visit. I can't find anything in the 1995 E/M guidelines that indicates we must get the patient's vitals for every visit and I can't find anything on the Medicare website. Could you direct us to some guidance?

The final version of the 2010 Medicare Physician Fee Schedule (PFS) will eliminate consultation codes and sets the conversion factor at $28.4061 -- a drop of 21.2% as mandated by the sustainable growth rate (SGR) formula.

When your providers order any kind of supplies or durable medical equipment (DME), all their enrollment information must be present in CMS's Provider Enrollment Chain Ownership System (PECOS). If they aren't, you should be getting a warning notice from your carrier - and starting Jan. 1, 2010, you'll get an instant denial on every DME claim filed on behalf of a provider not in PECOS.

Attempts in the Senate to kill the 21.5% cut to Medicare reimbursements set for next year and enact a more permanent fix failed on Oct. 21 - leaving you and your peers about 75 days from the nightmare scenario of a crippling pay decrease.