Part B Insider (Multispecialty) Coding Alert

Published on Sun Nov 05, 2006 PDF

Good news: Expect a boost in E/M reimbursement despite blanket cuts

Your Medicare reimbursement could take a sharp dive next January, especially if you perform any imaging services. The Centers for Medicare & Medicaid Services (CMS) roared ahead with several controversial proposals in the final regulation for the physician fee schedule, including:

- A 5.0-percent cut to your conversion factor (down from 5.1 in the proposal);

- A cap on the technical component of imaging services at the hospital outpatient rate;

- Sweeping changes to practice-expense RVUs, phased in over four years; and

- An across-the-board cut to work RVUs to pay for sharp increases in work RVUs for some evaluation & management codes.

Deaf ears: Physician associations had asked CMS to revise, or delay, some of these changes, to no avail.

For example, the Society for Interventional Radiology and other radiology societies had asked CMS not to impose the outpatient cap on radiological supervision & interpretation for guidance with surgeries. SIR had argued that the cap could force many surgeons to perform open, instead of laparoscopic, surgeries because radiologic guidance wouldn't be cost-effective.

Also, many physician societies had asked CMS to replace the cut to work RVUs with a cut to the overall conversion factor, to spread out the pain. But CMS went ahead with the work RVU cut.

CMS says it's still considering extending this year's demonstration project to pay oncology practices for reporting quality information. CMS will continue to pay a -preadministration fee- for intravenous immune globulin (IVIG) to help doctors cope with shortages.

CMS accepted all 400 of the Relative Value Unit Update Committee (RUC)'s recommendations for changing the RVUs of codes. CMS also went ahead with 150 of its own recommendations, acting deputy administrator Herb Kuhn told a conference call with reporters.

Bright side: You should still notice some pretty -powerful- increases in your reimbursement for mid-level E/M codes, in spite of the cut to the conversion factor and the across-the-board reduction in work RVUs, Kuhn promised.