Part B Insider (Multispecialty) Coding Alert

Published on Tue Oct 07, 2008 PDF

But budget neutrality adjustment softens the blow, offering 1.1 percent boost.

Don't lose heart when you see CMS' 2009 conversion factor of $36.066 -- a drop from this year's $38.0870. CMS attempts to make up for the lower conversion factor by boosting the budget neutrality adjustment by 1.1 percent.

Therefore, despite the lower conversion factor, the relative value units (RVUs) for some procedures have gone up (see page 307 for information in which procedures and specialties benefited from the new fee schedule, and which suffered).

"There is a 6.5-percent, five-year practice expense reduction that has been in the works for the past five years, so without the 1.1 percent increase, we would be seeing a 6.5 percent overall decrease in reimbursement," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions. "Instead, we are now seeing a 5.4 percent decrease."

Incentives: Practices may garner an additional two-percent bonus if they participate successfully in the PQRI program, and physicians are eligible to earn two percent of their total Medicare allowed charges if they adopt e-prescribing systems.

"E-prescribing can greatly reduce the number of medication errors that jeopardize the health and safety of Medicare patients and waste precious health care dollars treating conditions that never should have happened," said CMS Acting Administrator Kerry Weems in an Oct. 30 statement.

Credentialing: The fee schedule final rule dramatically changes how you can bill when you're waiting for your physician to acquire Medicare credentialing status.

Currently, practitioners can retro-actively bill the Medicare program for services that they rendered up to 27 months prior to being enrolled to participate in the Medicare program. But in the future, that 27-month period shrinks down to a 30-day window., according to the final rule.

To review the fee schedule and learn how to submit comments, visit the CMS Web site at www.cms.hhs.gov/physicianfeesched/downloads/CMS-1403-FC.pdf?agree=yes&next=Accept.