ED Coding and Reimbursement Alert

2011 will conclude with a Medicare Conversion factor (the Medicare payment per RVU) of $33.9764. The Congressionally mandated SGR (Sustainable Growth Rate) formula remains active and with the expiration of the latest congressional "patch" on Dec.31, 2011, the 2012 CMS Physician Fee Schedule Final Rule published a conversion factor of $24.6712 representing a 27.4 percent cut to physician payments, says Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, an ED coding and billing company in Bedford, MA.Congress has acted each year since 2003 with a variety of short term patches; however, the current debt crisis has cast doubt over the possibility of a repeal of the SGR formula. The SGR repeal would cost $300 billion over ten years, says Granovsky. The Medicare Payment Advisory Commission (MedPAC), an advisory body to HHS, has proposed a fix that would freeze current payments to primary care physicians for ten years, while cutting [...]