ED Coding and Reimbursement Alert

Scheduled 5.1 percent decrease scrapped at the last minute
 
On its way out the door, the 109th Congress left a nice gift for physicians and Medicare patients: It overturned the 5.1 percent reduction on Medicare payments that was supposed to take effect Jan. 1.

The legislation will stop the cut to the conversion factor on Medicare physician payments in 2007. Instead, there will be a one-year update of 0 percent to the physician fee schedule. Further, the action will set aside money to avert similar payment cuts in 2008 and prevent any further reductions in pay for rural physicians, Cecil Wilson, MD, AMA board chair, said in a statement.

-Congressional action to avert next year's Medicare physician payment cut will help avert a potential sharp decline in access for America's seniors. The AMA sincerely appreciates the bipartisan efforts by House and Senate leaders, committee chairmen, ranking minority members and congressional staff to prevent the Medicare cut triggered by the flawed Medicare physician payment formula,- Wilson said.

The numbers: To keep the reimbursement rate the same, Congress approved a freeze that will keep the conversion factor at the current 2006 rate of $37.8975 instead of decreasing it to the scheduled 2007 rate of $35.9848. At press time, President Bush had not signed the legislation but was expected to before Christmas.

The cut aversion was welcome news to the AMA, which was particularly worried about how the fee cut would affect physicians- ability to care for seniors.

-If the 2007 cut had occurred as planned, nearly half of physicians [polled] told the AMA the cut would force them to limit the number of new Medicare patients- they could take on, according to Wilson's statement.

However, there is still work to be done to avoid a future financial crunch on Medicare payments.

-The AMA renews its commitment to work with Congress, the administration and senior groups on a more permanent solution to the flawed Medicare physician payment formula. The time is long overdue to devise a sound financing system for the Medicare program so we can avoid this annual struggle to preserve seniors- access to care,- Wilson said.

ED benefit: As a result of the cut aversion, EDs will now see the full benefit of the added work relative value units (RVUs) assigned to the ED E/M services by the Relative Value Update Committee.