Ob-Gyn Coding Alert

Plus: Learn two new HCPCS codes if your physician performs wellness visits.

Get ready for another year of nail-biting to find out whether your Medicare payments will be slashed. "The calendar year 2011 Physician Fee Schedule conversion factor is $25.5217," notes the 2011 Medicare Physician Fee Schedule Final Rule, printed in the Federal Register that will be published on Nov. 29. This amounts to a dismal 30 percent cut compared to the current rate of $36.8729.

"While Congress has provided temporary relief from these reductions every year since 2003, a long-term solution is critical," CMS notes. "We are committed to permanently reforming the Medicare payment formula." As you know, last June, Congress voted to not only stave off a 21 percent cut to your Medicare pay, but to increase your revenue by 2.2 percent. However, that vote only kept the cuts at bay through November 30. Now, the Senate passed a bipartisan bill that postpones this cut one month -- and that date is right around the corner. Effective January 1, your Medicare pay is set to drop by over 23 percent, unless Congress intervenes to reverse the cuts. Add to that the fact that 2011 payments are due to drop even further starting January 1, and medical practices are facing a perfect storm of payment nightmares.

Practices are currently in the dark about what will transpire when the calendar turns to 2011. "We have no idea what will happen in Congress in January regarding the conversion factor," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. Some newly elected Senators and House members will be in place.

But before you think the sky is falling, there is also a bright side that most people ignore. Almost every procedure code reported by ob-gyns will see an increase in relative value units (RVUs) in 2011 due to increases in both the practice expense and malpractice expense elements that help to make up total RVUs. If your commercial payers use these units for determining your payment levels, you may see an increase in revenue from those insurers. But be forewarned: You may have to renegotiate your current contract to implement the new values if this language is not already contained in your current contract with payers.