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December 2010 Client Newsletter

CPB Holiday schedule

CPB will be closed on Christmas Eve (Friday, December 24th), and New Years Day Eve, Friday, December 31st. We hope you enjoy the holidays!

PECOS – cms just “blinked”

CMS announced on November 24th that the automated edits will not be turned on effective January 3, 2011. They are working diligently to resolve enrollment backlogs and other system issues and will provide ample advanced notice to the provider and beneficiary communities before we begin any automatic nonpayment actions.

Medicare 2011 Fee Schedule

As you know, Medicare payment rates under the Medicare Physician Fee Schedule (MPFS) are set according to statutory criteria. Medicare has released the 2011 MPFS payment rates which are reflective of the 2011 Physician Fee Schedule Final Rule and are based on current law which provides a negative update for 2011. Before Thanksgiving, the House approved a 1 month delay in a 23% decrease that will take effect on December 1, 2010. The House approved the same measure on November 29 and the President is expected to sign the bill. However, this is only a 1 month reprieve while Congress attempts a permanent fix. Highmark Medicare has suggested affected practitioners consider the possibility of this legislation as you evaluate decisions related to your annual participation election. We will notify you about the 2011 physician update as more information becomes available at the end of December.


I just returned from a 3 day EHR/EMR conference with multiple seminars and reviewed 7 different EMR programs. Each had its own unique approach with different features and ways to use and access them. Purchasing an EMR is a BIG decision. If you haven't already, I strongly recommend that you review at least 5 different vendors to make sure your money is well spent and you can see what the range of quality is. It is important for you to look at each as it would work for your own practice - does the workflow match your office? If you dictate, does it support it?

You and your staff that will use the EMR needs to view it - is it easy to use? Does it capture data the way you practice medicine? Does it support eRx and PQRI? Does it give you the flexibility to use any clearinghouse, patient statement vendor, or export claims to a billing service? You may not choose to use those options, but by having them you retain the ability to make changes if your payments are not what they need to be.

And, very importantly, is it certified as meeting the CURRENT "meaningful use" (MU) criteria? No 2011 certification means no incentive payment from CMS! If it has never been certified, it would be wise to be very careful.

We are also hearing that some vendors are offering to contractually "guarantee" they will meet the current MU criteria. That may not be very good - if they cannot afford to get the certification before you purchase, then what guarantee can they provide if they do not get the certification or go out of business? If they don’t you lose the incentive payment and have to buy new EMR software!


The Centers for Medicare & Medicaid Services (CMS) announced the Part B annual deductible for 2010 is $162.00 (it was $155 in 2010). With the poor economy, it is more important than ever to make every effort to collect all co-pays, deductibles (if known), and co-insurances on the date of service. The key is getting the payment before they receive your services, or at worst, before they leave your office.

Also, just a reminder that cash flow will be slow for the first 2-3 months of the year due to the current economy and patients showing greater reluctance to visit their physicians.


Each year CPB prepares a table with the Medicare Allowable Amounts for your commonly used office CPT codes. If you would like to receive this again in 2011, please notify Rich by December 13th.


The Therapy Cap for 2011 is $1,870 through for 2011. The Medicare Cap Exceptions process for independently practicing physical, speech and occupational therapists appears to have been extended 2011. However, as it currently stands for 2011, Medicare PT/OT fees will be cut for multiple services during a single episode of care after the first CPT code to 75% of the Allowed Amount for the Practice Expense component of the remaining approved CPT codes. The US Senate has approved a reduction in the decrease from 25% to 20% (paying 80%) but we will need to see what the House does.
2010 Client Newsletter Archive