ED Coding and Reimbursement Alert

Remember that huge cut to the conversion factor rate that was supposed to go into effect Jan. 1? It's been delayed -- which is good news for any practice that did not want their services devalued by almost 22 percent.

Despite CMS's plans to downgrade your 2010 conversion factor by 21.29 percent, Congress stepped in at the last minute and offered you a temporary reprieve. Facing grim cuts in Medicare pay, Congress voted to delay a decrease to the conversion factor until March 1.

The $kinny: President Obama signed the temporary pay fix into law on Dec. 19. CMS subsequently issued MLN Matters article MM6796, which announced that due to relative value unit (RVU) adjustments, the conversion factor during the two-month temporary pay fix period would not remain at the 2009 level of $36.0666, but would instead rise about two cents to $36.0846.

This temporary fix is being considered a "bridge" to help physician payments stay stable while a more permanent fix is still up in the air, as Congress hasn't made a decision on whether to permanently change the sustainable growth rate (SGR) formula.

Plus: To give Medicare administrative contractors (MACs) time to adjust their fee schedules and claims systems based on the new conversion factor boost, CMS has instructed its contractors to hold Medicare claims for 2010 dates of service "for the first 10 business days of January (January 1 through January 15)," according to a Dec. 21 CMS listserve notification.

"The 10-day claims hold is to ensure that the adjusted conversion factor and the RVUs for 2010 come through properly on your claims," says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of CRN Healthcare Solutions in New Jersey.

"This is why I don't advise that people submit claims based on the carrier's fee schedule," Cobuzzi says. "You should submit claims based on your fees, and when Jan. 15 comes around, the MAC will pay the claim based on the appropriate fee schedule amount." (To read MLN Matters article, visit www.cms.hhs.gov/MLNMattersArticles/downloads/MM6796.pdf.)