Sunny with a chance of gloom
There is potential good news on the Medicare horizon as far as family physicians are concerned. However, the silver lining is attached to a big, black cloud that could rain on everyone's parade unless Congress intervenes by the end of the year.
On Friday, Oct. 30, the Centers for Medicare and Medicaid Services (CMS) put the final rule on the 2010 Medicare physician fee schedule on display for review and comment by all interested stakeholders. CMS plans to publish the final rule in the Federal Register on Nov. 25, 2009. CMS will accept comments until Dec. 29, 2009.
In the final rule, CMS finalized many of the proposals that it made in its proposed rule earlier this year. For those of you keeping score at home, that's good news for family physicians. In fact, in the final rule, CMS estimates that family physicians will experience a 4 percent increase in their Medicare allowed charges in 2010 as a result of the rule, all other things being equal. That is second only to ophthalmologists and optometrists, who are projected to reap a 5 percent increase, and much better than physicians in many other specialties, who are expected to see a decrease in their 2010 Medicare allowed charges as a result of the rule.
Of course, with Medicare, there's always a catch, and the final rule on the 2010 physician fee schedule is no exception. Under current law, the Medicare conversion factor, which translates Medicare's relative value units into payment allowances, is scheduled to decrease 21.2 percent on Jan. 1, 2010, which would more than wipe out the potential gains for family medicine noted above. That means Congress has until Dec. 31, 2009, to intervene, as it has the last several years, to avoid this cut. Forecasters inside the Beltway are optimistic, but as they say on Wall Street, past performance is no indication of future returns.
So, as we approach the new year, the outlook is sunny, but you might want to keep your umbrella handy, just in case.
Posted at 02:17PM Nov 05, 2009 by Kent Moore | Comments[0]
You might be a coding and payment geek if . . .
The arrival of the new ICD-9 manual recently reminded me that there are certain things that distinguish coding and payment geeks from otherwise "normal" people. So, for your consideration, I offer you the top 10 signs that you might be a coding and payment geek:
10. The first thing you associate with December is the arrival of the new CPT book.
9. You actually get excited when your new coding books arrive.
8. You wonder why the toy doctors bag you bought your kid doesn't include a claim form.
7. You worry your family physician is undercoding your visit.
6. You consider the Federal Register light reading.
5. You write to CMS more than to your own mom.
4. You actually understand Medicare's Sustainable Growth Rate formula.
3. You collect past issues of CPT Assistant on eBay.
2. When your family physician tells you that you have conjunctivitis, you wonder what the ICD-9 code for that is.
And the number one sign that you might be a coding and payment geek:
1. You actually understood the humor in this blog post!
Posted at 01:10PM Oct 22, 2009 by Kent Moore | Comments[0]
Potentially good news on the Medicare horizon
I don't normally recommend reading the Federal Register unless you're a masochist or have trouble sleeping. However, last month, the Centers for Medicare and Medicaid Services (CMS) published its proposed rule on the 2010 Medicare physician fee schedule in the Federal Register, and there is actually some good news for family physicians in what CMS is proposing.
Among the proposals that CMS estimates will have a positive impact on family physicians, two are most significant. One is that CMS proposes to use more current physician practice cost data in its calculation of practice expense relative value units. The other is that CMS proposes to increase the relative values of office visits and initial hospital visits in conjunction with a proposal to no longer recognize and pay consultation codes. CMS estimates that the impact of these changes would result in approximately an 8 percent increase in Medicare allowed charges for family physicians in 2010. Not surprisingly, the AAFP has commented in support of both proposals.
Of course, every silver lining is attached to a cloud. In this case, the cloud is a 21.5 percent decrease in the Medicare conversion factor for 2010 if Congress does not intervene between now and Jan. 1. Here's hoping the folks on Capitol Hill get around to that, whether or not they get around to health care reform in general.
CMS is accepting comments on the proposed rule until Aug. 31. You can submit comments online or by other means specified in the proposed rule.
Posted at 03:32PM Aug 12, 2009 by Kent Moore | Comments[0]
The check may yet be in the mail
I know it's 2009, but Medicare's 2007 Physician Quality Reporting Initiative (PQRI) continues to make news.
Those of you who have been following this saga may recall that a lot of physicians who thought that they should have received a bonus check for participating in the 2007 version of PQRI never did. It turns out that some of them probably should have, after all.
In a set of new PQRI frequently asked questions posted on the Centers for Medicare and Medicaid Services (CMS) web site, CMS confirmed that it is re-running the 2007 PQRI feedback reports and incentive payments. According to CMS, it investigated reported issues following delivery of the 2007 PQRI feedback reports and incentive payments and determined that several unanticipated technical issues could be corrected by conducting back-end system analytics and re-running the data. New reports are anticipated to be available in the fall of 2009.
These new reports will be available only for those eligible professionals who have qualified due to the back-end system analysis and re-running the data. That means if you already received an incentive for 2007, the re-run will not apply to you, and you will not receive an additional feedback report. For those that do qualify, feedback reports will be available via the PQRI Reports Delivery System, for which an Individuals Authorized Access to the CMS Computer Services (IACS) user name and password will be required to access.
Interestingly, there will also be a 2007 PQRI re-run for Medicare Advantage participants. Thus, those Medicare Advantage eligible professionals who previously did not receive a bonus but are bonus eligible following the back-end system analysis and re-run of the 2007 PQRI data will potentially receive the 2007 re-run incentive.
So, if you thought you were owed a 2007 PQRI bonus check, you may still be right. Unfortunately, you won't find out for sure until this fall. Think of it as Christmas in October ... from the U.S. Department of Better Late Than Never.
Posted at 03:53PM Jun 15, 2009 by Kent Moore | Comments[0]
Mental health parity to come to Medicare
By law, Medicare payment for outpatient mental health services is limited to 62.5 percent of covered expenses incurred in any calendar year in connection with the treatment of a mental, psychoneurotic or personality disorder for an individual who is not a hospital inpatient at the time the expenses are incurred. The limitation is typically triggered by the primary diagnosis on the claim, and the limitation essentially changes the usual 80/20 Medicare/beneficiary payment responsibility to a 50/50 split. The physician is essentially held harmless.
For a more thorough explanation of the limitation and its implications, please see the article "Understanding Medicare's Mental Health Treatment Limitation," which appeared in the November/December 2000 issue of Family Practice Management.
Thanks to the Medicare Improvements for Patients and Providers Act (MIPPA), this limitation will be phased out over the next few years. Specifically, Section 102 of MIPPA provides that, beginning in 2010, for expenses reflecting the Medicare approved amount that are incurred in a calendar year in connection with the treatment of outpatient psychiatric services, Medicare will begin to increase the percentage (currently 50 percent) that it will cover as follows: 55 percent of expenses incurred in 2010 or 2011; 60 percent in 2012; 65 percent in 2013; 80 percent in 2014 or in any subsequent calendar year. Thus, MIPPA will gradually phase beneficiary coinsurance rates for outpatient mental health services down to 20 percent by 2014.
Look for the Centers for Medicare and Medicaid Services to address its implementation of this provision this summer in the proposed rule on the 2010 Medicare physician fee schedule.
Posted at 04:28PM May 13, 2009 by Kent Moore | Comments[0]
Pay for performance: It's not just for doctors anymore
It's a different interpretation of pay for performance, but the concept does apply to Medicare's Recovery Audit Contractors (RAC) program. Physicians in California and other states involved in the demonstration program may already understand the ramifications of this effort to recover improper Medicare payments. Now that the permanent program for RACs is gearing up across the country, it's important for all physicians to understand how it works.
The RAC program is different from Medicare safeguard audits like Comprehensive Error Rate Testing (CERT) that focus on identifying error rates for the Medicare payment contractors or postpayment review audits performed by individual carriers. RACs contract with the Centers for Medicare & Medicaid Services to perform post-payment reviews of Medicare claims to find overpayments and underpayments in return for a percentage (from 9 percent to 12.5 percent) of the amounts recovered. Put simply, they eat only what they kill. According to an evaluation of the three-year demonstration program, RACs returned $693.6 million to the Medicare trust funds, after subtracting the dollars in refunded underpayments, overpayments overturned on appeal, and operating costs for the program.
The RAC has two methods of uncovering improper payments - using computer software to analyze claims and auditing medical records. Hospital claims will likely continue to be a focus of their efforts, as was the case in the RAC demonstration program. However, hospitals have mobilized to defend themselves against RAC recoveries. At this time, physicians should not be overly concerned about being targeted but must not expect to be exempt from the program.
You should be aware of your rights in relation to records requests and refunds and how you might avoid some problems. If your practice does not have policies and processes in place to be sure that records sent in response to a payer/auditor request are appropriately screened for accurate dates of service and completeness and returned within the required time frame, I hope you'll schedule a few minutes to discuss the importance of this and establish a standard for your practice. It could save you money and headaches.
The AAFP has joined others in asking CMS to make changes to the program to lessen the burden and the risk to physicians. The AAFP has also put together an online guide to answer questions about the RACs and provide some tips that may help lessen the burden if an RAC does contact you.
It's a shame that honest physicians need to concern themselves with programs like this one, but here's hoping that the contractors do a good job of finding and stopping those few who create most of the concerns about fraud and abuse. They are out there, and now there are bounty hunters looking for them.
Have you had any experience with an RAC? Has the RAC contractor for your area provided any education to physicians? If you have tips that may help your fellow physicians, I hope you will share them.
Posted at 04:17PM Apr 03, 2009 by Cindy Hughes | Comments[0]
The future of diagnosis coding
The Centers for Medicare & Medicaid Services (CMS) announced the future of diagnosis coding for physicians last week. Specifically, on Jan. 16, CMS published a final rule specifying that by
The good news is that you have almost five years to get ready, which is two years longer than CMS originally proposed. The bad news is that you will still have to make systems changes and train yourself and your staff to use the new codes.
In the meantime, you and your practice will also have to comply with an updated X12 standard, Version 5010, for certain electronic health care transactions, including claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Version 5010 accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard. The compliance deadline is
They say that “forewarned is forearmed.” Please consider yourself “forewarned” and anticipate that Family Practice Management, the
Posted at 05:15PM Jan 21, 2009 by Kent Moore | Comments[0]
