Part B Insider (Multispecialty) Coding Alert

Published on Fri Dec 21, 2012 PDF

Reps remain hopeful that Congress will act before conversion factor drops to $25.008 on Jan. 1.

Although lawmakers haven’t yet reversed the huge Medicare cuts that loom effective Jan. 1, CMS reps haven’t given up hope that it will happen in time to ensure your claims don’t suffer. That’s the word from a Dec. 19 CMS Open Door Forum, where agency representatives shared information and answered questions about pressing Part B issues.

"The negative 27 percent update is still scheduled to go into effect on January 1, 2013," said CMS’s Stewart Streimer during the call. "We’re working very closely with Congress and listening very closely to their deliberations in terms of what might happen as a result of that. Right now, I don’t have any specific news for you. We are not holding claims at this point in time but it’s still only December 19….Hopefully Congress will act quickly and we will be able to pay claims correctly the first time come January 1, 2013."

A caller to the forum asked whether the two percent sequestration cut would also go into effect as planned. CMS didn’t have a concrete answer but Streimer was hopeful that the cuts wouldn’t hit. "At this time we are working closely with the Hill and monitoring deliberations there, but at this point we’re hopeful that Congress will take action and we won’t have to have sequestration cuts. As we get closer to the end of the year we will take a closer look at that and discuss that with the leadership in the department and the Office of Management and Budget, and we will move from there."

Continued HPSA Bonuses Aren’t Guaranteed

If you’ve been enjoying bonuses due to your location in a healthcare professional shortage area (HPSA), check the CMS Web site before assuming that bonuses will carry over to 2013.

"The CMS physician bonus is paid to physicians who are in geographic HPSAs designated as of December 31 of the prior year," said CMS’s Corinne Axelrod during the call. "Eligibility is determined every year. If you were eligible during 2012, you may not be eligible in 2013, and if you weren’t eligible in 2012 you may be eligible in 2013," she added.

To determine whether your area is designated as a geographic primary care HPSA as of December 31, check the CMS Web site at http://bhpr.hrsa.gov/shortage/shortageareas/index.html."We do publish a list on our site of areas eligible to receive the bonus automatically (without adding a modifier)," Axelrod said. "If you are eligible for the bonus but not on that list, you’ll need to use the modifier on your claims," she added, referring to modifier AQ (Services provided in a Health Professional Shortage Area [HPSA]). "Only use the modifier in 2013 if you’re furnishing services in an area designated as a geographic HPSA as of December 31, 2012."

For more information on the HPSA bonuses, visit http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/.

More primary care good news: Don’t forget that Medicaid pay will increase for primary care physicians in 2013, added CMS’s William Rogers, MD during the call. "All primary care physicians should be aware of the fact that beginning in January, rates for Medicaid primary care services will be brought in line with the Medicare Physician Fee Schedule," Rogers said. "We look forward to enthusiastic participation by primary care physicians when this happens."