ED Coding and Reimbursement Alert

Downside: Increase also triggers a drop in the conversion factor.

You’re getting a 2015 bonus gift, courtesy of CMS. On Dec. 29, 2014, CMS released notice of a technical correction that affects the 2015 relative value assignments of key ED services.Here’s the lowdown on the changes and what they’ll mean for your bottom line.

These new values update the RVUs listed in the Medicare 2015 physician fee schedule final rule published in November 2014. (See ED Coding & Reimbursement Alert Vol. 17, No.12.)

The skinny:The primary changes are in the professional liability RVUs, says Michael Granovsky, MD, FACEP, CPC, President of LogixHealth, a national ED coding and billing company based in Bedford MA. “Although the total RVUs dropped for a level one ED E/M service and remained unchanged for a level two, we now see increases in total RVUs for levels three for and five as well as both the critical care codes. Based on national Medicare frequency distributions, that means RVU increases in the codes that are reported a vast majority of the time for Medicare patients” he explains.

Note the Conversion Factor Downside

To offset the increased cost in expected Medicare payments, CMS has reduced the 2015 conversion factor from $35.8013 to $ 35.7547 or about seven cents per RVU from the 2014 conversion factor of $35.8228. Depending on the exact medical service in question, the combined increase in RVUs and decrease in the conversion factor could net either a slight increase or a slight decrease for that given service.

Silver lining:Fortunately for emergency medicine, the CPT® codes that reflect the most commonly billed services in the ED net out with slight increases, explains Granovsky.

Expiration date:This conversion factor change only applies for the period of January 1 through Mar. 31 2015, at which time the current SGR patch expires. If Congress fails to pass an SGR fix or at least another patch before the end of March, the conversion factor would drop significantly, resulting in payment decrease of over twenty percent, Granovsky warns.

Two Week Delay In Processing Claims Announced

Medicare Administrative Contractors (MACs) are going to need time to update their payment files with these last minute changes. Therefore CMS has announced that it will hold claims for service in 2015 under the Medicare physician fee schedule for the first fourteen calendar days of January.

In reality, this will have a minimal impact on claims payments since by current law Medicare doesn’t pay claims immediately but is mandated to make payment of clean electronic claims in fourteen days and twenty nine days for paper claims, after the date of receipt, says Granovsky.