Optometry Coding & Billing Alert

Published on Thu Aug 24, 2006 PDF

Here's a checklist of what the future holds

These are the times that try coders- and billers- souls. With so many changes being talked about for next year, it's hard to know what's written in stone and what's scribbled in sand.

But don't worry. Here's a list of some changes that have actually become law or final regulations, along with some changes that have been proposed but aren't final yet. (Of course, Congress could always go back and rewrite the law, and the Centers for Medicare & Medicaid Services could change its regulations.)

Fee schedule cut: Once again, the law calls for your payments to fall by about 4.6 percent next year, unless Congress acts. Congress has acted to prevent the last few cuts, but it allowed a steep cut to go through in 2002. Since this is an election year, you can expect some change, says Quinten Buechner, MS, MDiv, CPC, president of ProActive Consulting in Cumberland, Wis.
 
Status: final--for now.

Work RVUs: In a June proposed rule, CMS said it wants to boost the work relative value units (RVUs) for a handful of E/M codes next year. To pay for this change, CMS would cut all work RVUs across the board by 10 percent. Some other work RVUs would also see some boosts.

-The problem with this is it gives with one hand and takes with another, because of the budget neutrality,- says Barbara McAneny, a physician in Albuquerque. -It's two steps forward and one step back.- Medicare should just recognize that physicians are cutting costs in hospitals by doing more things in their offices, McAneny adds. Instead, hospitals get pay hikes every year and physicians have spending caps.

Status: proposed regulation.

PE-RVUs: The June proposed regulation also said CMS wants to move practice expense RVUs (PE-RVUs) to a new system, based on data from surveys your specialty societies performed.

The technical components of some codes could drop by about 60 percent. In 2007, CMS would use the new method to set 25 percent of PE-RVUs. The percentage of PE-RVUs based on the new system would rise to 50 percent in 2008, 75 percent in 2009 and 100 percent in 2010.

Status: proposed regulation.