ED Coding and Reimbursement Alert

2011 will conclude with a Medicare Conversion factor (the Medicare payment per RVU) of $33.9764. The Congressionally mandated SGR (Sustainable Growth Rate) formula remains active and with the expiration of the latest congressional "patch" on Dec.31, 2011, the 2012 CMS Physician Fee Schedule Final Rule published a conversion factor of $24.6712 representing a 27.4 percent cut to physician payments, says Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, an ED coding and billing company in Bedford, MA.

Congress has acted each year since 2003 with a variety of short term patches; however, the current debt crisis has cast doubt over the possibility of a repeal of the SGR formula. The SGR repeal would cost $300 billion over ten years, says Granovsky.

The Medicare Payment Advisory Commission (MedPAC), an advisory body to HHS, has proposed a fix that would freeze current payments to primary care physicians for ten years, while cutting specialists by 5.9 percent in each of the next three years before freezing non-primary care physicians for seven years at rates that include a 17.7% reduction.

The Med PAC proposal, although initially sparking some interest in Congress, currently does not seem to be gaining traction. After significant debate in Congress on how to solve this crisis, at the time of this writing speculation is that a similar patch will occur for 2012, perhaps for two years, that would keep the conversion factor fairly stable at current levels, adds Granovsky.