Medicare Compliance & Reimbursement

Reimbursement:

Don't Miss This Increase in the Medicare ACF for All 2012 Claims

Published on Tue May 15, 2012

Re-analyze your claims for Q1 services that deserve higher pay.

You have reason to celebrate good news for your practice's bottom line, thanks to a recent reimbursement clarification from CMS. The American Society of Anesthesiologists (ASA) has clarified that previously announced changes to the Medicare anesthesia conversion factor (ACF) resulted from an error in the original calculations of the CY 2012 ACF.

Result: CMS instructed its contractors to update their claims processing files to use the updated locale-specific conversion factors by March 15, 2012.

Now that the revision is in place, the total increase in unadjusted ACF from CY 2011 to CY 2012 is 2.0 percent. Locale-specific ACFs increase from $0.08 to $0.13 per unit, which translates to an additional increase of 0.42 percent to 0.59 percent above the originally posted ACFs per locale.

Consider a few examples:

Alabama's ACF increased from $20.05 to $20.14
San Francisco's ACF increased from $22.81 to $22.94
Chicago's ACF increased from $24.08 to $24.19
Metropolitan Boston's ACF increased from $21.71 to $21.83

"It's fairly straightforward," says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. "For example, take an anesthesia case valued at five units. If you're coding for Alabama, the case will be worth 45 cents more under the new rate ($100.70 under the new rate and $100.25 under the old rate)."

Important: CMS contractors will not automatically reprocess claims paid under the originally published ACF. You'll need to notify CMS of any claims from your anesthesia providers that should be reprocessed.

Next step: Analyze your Medicare claims for services provided from Jan. 1, 2012 through March 14, 2012. If increased revenue offsets your administrative costs, request that CMS reprocess your claims for this time frame.

Medicare Compliance & Reimbursement

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