Medicare Compliance & Reimbursement

But expect a 1.1 percent budget neutrality adjustment boost.

The 2009 conversion factor has dropped from $38.087 to $36.066, but CMS is boosting the budget neutrality adjustment by 1.1 percent.

Therefore, despite the lower conversion factor, the relative value units (RVUs) for some procedures have gone up (see page 307 for information in which procedures and specialties benefited from the new fee schedule, and which suffered).

"There is a 6.5-percent, five-year practice expense reduction that has been in the works for the past five years, so without the 1.1 percent increase, we would be seeing a 6.5 percent overall decrease in reimbursement," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions. "Instead, we are now seeing a 5.4 percent decrease."

Incentives: Practices may garner an additional 2 percent bonus if they participate successfully in the PQRI program, and physicians are eligible to earn 2 percent of their total Medicare allowed charges if they adopt e-prescribing systems.

"E-prescribing can greatly reduce the number of medication errors that jeopardize the health and safety of Medicare patients and waste precious health care dollars treating conditions that never should have happened," said CMS Acting Administrator Kerry Weems in an Oct. 30 statement.

Credentialing: The fee schedule final rule dramatically changes how you can bill when you're waiting for your physician to acquire Medicare credentialing status.

Currently, practitioners can retro-actively bill the Medicare program for services that they rendered up to 27 months prior to being enrolled to participate in the Medicare program. But the final rule shrinks down that 27-month period to a 30-day window.

To review the fee schedule and learn how to submit comments, visit the CMS Web site at http://www.cms.hhs.gov/physicianfeesched/downloads/CMS-1403-FC.pdf?agree=yes&next=Accept