The document discusses how the Patient Protection and Affordable Care Act (PPACA) will impact Medicare payments and billing procedures. Key points include: 1) The PPACA establishes annual wellness visits for Medicare beneficiaries starting in 2011 that are not subject to deductibles or coinsurance. 2) Starting in 2011, primary care physicians will receive a 10% bonus on Medicare payments if they bill at least 60% of services as primary care. 3) Claims must now be submitted within one calendar year of the date of service instead of 15 months, effective January 2010. 4) Several other payment increases and changes take effect between 2010-2015, including bonuses for services in underserved areas and an extension