Emergency Update to Physician Payment Files

The Medicare Physician Fee Schedule Database (MPFSDB) has been revised to include MPFS policy and payment indicator revisions, as well as relevant statutory changes applicable Jan. 1, 2011. The Centers for Medicare & Medicaid Services (CMS) issued a 2011 MPFS Final Rule Correction Notice to revise some physician work, practice expense (PE) and malpractice (MP) relative value units (RVUs) set forth in the 2011 MPFS Final Rule, published in the Nov. 29, 2010 Federal Register. Subsequent legislative changes occurring after the publishing of the correction notice have made additional revisions affecting Medicare payments to physicians necessary. 

Of particular note, the Medicare and Medicaid Extenders Act of 2011, which President Obama signed into law Dec. 15, 2010, averts the negative update that would have otherwise taken effect Jan. 1 and provides a zero percent update to the MPFS for claims with dates of service Jan. 1, 2011 through Dec. 31, 2011.

While the PFS update is zero percent, other changes to the RVUs are budget neutral. To make those changes budget neutral, CMS must make an adjustment to the conversion factor (CF). The revised CF to be used for physician payment as of Jan. 1, 2011 is $33.9764.

A summary of the other recent statutory provisions included in the revised MPFS payment files is available in CMS Transmittal 828, Change Request (CR) 7300, issued Dec. 29, 2010.

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2 Responses to “Emergency Update to Physician Payment Files”

  1. Patricia McDonald says:

    Why would the allowable for a combined CT Abdomen and Pelvis be less than the allowable for just a CT of the Abdomen? We feel the new codes for combined CT Abdomen and Pelvis are unrealistic and should be immediately reviewed and recalculated with retroactive reprocessing of claims already sent.

  2. Robert Hughes says:

    Healthcare reimbursement is always difficult for me to understand but I was able to find in my Healthcare Reimbursement book that both Physician and nonphysician practioners are paid under the Medicare physician fee schedule.

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