ED Coding and Reimbursement Alert

New legislation tables 25 percent drop in 2011 Medicare pay.

ED practices won't face the same feeling of uncertainty about pay rates this year as they did in 2010, thanks to a Senate Finance Committee bill that will freeze Medicare pay at current levels for another 12 months.

On Dec. 29, 2010, CMS released Transmittal 828, which lists the Medicare Conversion Factor for 2011 as $33.9764. This is about a 7.9 percent drop from last year, but because of increases to the ED E/M code RVUs for 2011, the net pay difference will only be about 3 percent lower than in 2010.

Also, on Dec. 15, 2010, President Obama signed the Medicare and Medicaid Extenders Act (MMEA) of 2010 into law, delighting the AMA.

"The AMA welcomes bipartisan House passage of legislation to stop the Medicare physician payment cut for one year," said AMA president Cecil B. Wilson, MD, in a statement on Dec. 9. "Stopping the steep 25 percent Medicare cut for one year was vital to preserve seniors' access to physician care in 2011. Many physicians made clear that this year's roller coaster ride, caused by five delays of this year's cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could treat."

The bill was passed as a bipartisan effort, and the Senate Finance Committee noted that it will cost $14.9 billion over ten years to implement the physician pay fix. It will be funded by making minor adjustments to the Affordable Care Act, the health care legislation that Obama signed into law last March.

The bill also extends the exceptions process for Medicare therapy caps and extends payment for the technical component of specific pathology services through Dec.

31, 2011 -- as well as including other provisions. The full text of the legislation can be found on the Senate Finance Committee's Web page at http://finance.senate.gov/legislation.