Part B Insider (Multispecialty) Coding Alert

Published on Sat Nov 22, 2008 PDF

This quick tool will allow you to see whether you gain or lose in 2009.

Even if mathematic calculations aren't your forte, you can still determine how the new Medicare Physician Fee Schedule affects you by gathering a few simple facts.

As we indicated on page 345, your Medicare payments will vary in 2009 based on your location -- but your payments will also differ depending on your practice's procedure mix.

You can devise a spreadsheet of the fee schedule RVU units on your own -- or you can use a simple tool created for our readers by Frank Cohen, MPA, senior analyst with MIT Solutions, Inc. in Clearwater, Fla.

What you'll need: Gather a sampling of your practice's charts, and write down the percentage of your billings that are surgical, radiology, pathology, medicine-based,and E/M.

For this example, we'll hypothetically assume the following breakdown of your practice's procedures:

• Surgical: 20 percent

• Radiology: 10 percent

• Pathology: 10 percent

• Medicine procedures: 30 percent

• E/M procedures: 30 percent

Next: Access the spreadsheet on Cohen's Web site at www.mitsi.org, and click "downloads." Then open the document called "Comparison of GPCI Values by Location."

Find your location on the spreadsheet. For purposes of this example, we'll assume your practice is located in Alabama, which is listed first on the spreadsheet.

Move to columns W, X, Y, Z,and AA on the sheet, and enter the percentages that you determined your practice performs in each of the corresponding fields (for instance, using our example, you'd enter 20 in field "W," 10 in field "X," and so on.)

Once you've filled in all of the fields, scroll over to column AG to find your total adjustment in the GPCI for 2009. In this location (Alabama) using the practice distribution breakdown in our example, the practice's GPCI adjustment will increase by 11.65 percent, meaning that the practice will collect more reimbursement based on the GPCIthan it did in 2008.

The impact will change depending on both your practice mix and your geographic location. If you have practices in multiple areas, use the different rows to determine each area's impact.