ED Coding and Reimbursement Alert

Feds could still change cuts before implementation date.

Get ready for another year of nail-biting to find out whether your Medicare payments will be slashed. "The calendar year 2011 Physician fee schedule conversion factor is $25.5217," notes the 2011 Medicare Physician Fee Schedule Final Rule, printed in the Federal Register that will be published on Nov. 29. This amounts to a dismal 30 percent cut compared to the current rate of $36.0846.

"While Congress has provided temporary relief from these reductions every year since 2003, a long-term solution is critical," the fee schedule notes. "We are committed to permanently reforming the Medicare payment formula."

As most practices know, last June, Congress voted to not only stave off a 21 percent cut to your Medicare pay, but to increase your revenue by 2.2 percent. However, that vote only kept the cuts at bay through November 30 -- and that date is right around the corner. Effective December 1, your Medicare pay is set to drop by over 23 percent, unless Congress intervenes to reverse the cuts. Add to that the fact that 2011 payments are due to drop even further starting January 1, and medical practices are facing a perfect storm of payment nightmares.

Practices are currently in the dark about what will take place not only at the end of this month, but also regarding what will transpire when the calendar turns to 2011.

"We have no idea what will happen in Congress in January regarding the conversion factor," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. Some newly-elected Senators and House members will be in place in 2011, and it's unclear whether the current Congress will make changes affecting 2011 pay before January, or whether they'll leave the issues for the new Congress to handle, he says.

(As of press time, the Senate had passed a 30-day extension of Medicare physician payments by unanimous consent. The extension continues the 2.2 percent increase in Medicare reimbursements approved by Congress in June, 2010. The House had recessed for the Thanksgiving break so no action would take place before the very end of November at the earliest, when Congress resumes.)