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

Q. In order for a physician to bill observation services to Medicare, must the patient be located in an area the hospital designates as an "observation" area?

You're required to file a claim even when you don't accept assignment of the service, according to CMS. The agency recently spelled out its policy on your mandatory claims filing obligations and non-compliance is steep - there's a $2,000 fine for each violation of the requirement.

Usage of modifier 22 (increased procedural services) by you and your peers dropped 11% from 2005 to 2007, while Medicare denials of claims using the modifier steadily increased by more than two percentage points over that time, according to a Part B News analysis of CMS claims data.

The Practicing Physicians Advisory Council (PPAC) grilled CMS on its plans to use physician resource use reports that measure cost for individual physicians to the Medicare program. PPAC members believe the reports  could hurt practices if they are publicized, especially if information is incorrect.

You should not have received any demand letters or record requests from Recovery Audit Contractors (RACs) since March 2008, CMS officials said during a June 1 meeting of the Practicing Physicians Advisory Committee (PPAC).

This chart shows how Medicare spending has changed from 2007 to 2008 by category. Categories are based on the Berenson-Eggers Type of Service (BETOS) system; data comes from an April 2009 report by the AMA called "Estimated change in SGR spending from 2007 to 2008."

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

Q: None of our doctors participate but they all see some Medicare patients. Is it all right for us to give the patient form CMS-1490 and tell them to submit the claim or do we have to use the CMS-1500 and submit the claim?

The latest Medicare trustees report spells doom and gloom for the Medicare program in less than 10 years unless major action is taken. The Medicare trust fund will be exhausted by 2017, two years earlier than projected in last year's report (PBN 3/31/08).

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

Q.  Can we bill incident-to when a Nurse Practitioner is the "supervising provider" in the office? For example, can a PA bill under an NP's number?

This chart gives an estimate of the number of services billed to Medicare by each individual NPP, per specialty. NPP specialties with less than 30,000 individuals enrolled in Medicare were excluded from analysis. Every single physical therapist bills nearly four times the number of services that the next highest NPP specialty does.