Medicare Compliance & Reimbursement

Cardiologists, ED docs would suffer most from 9.9-percent cut.

Bad news: Your Medicare payments still face a cut of 9.9-percent next year, unless Congress acts.

That's the worst news in the 2008 physician fee schedule proposed rule, released by the Centers for Medicare & Medicaid Services (CMS).

The biggest losers would be cardiologists, emergency department (ED) physicians, hand surgeons, interventional radiologists, nephrologists, neurosurgeons, rheumatologists, thoracic surgeons and vascular surgeons. The biggest winners from the new rule would be audiologists, optometrists, nuclear medicine physicians, geriatricians and dermatologists. 

The good news: CMS decided to accept a number of recommendations from the American Medical Association's Relative Value Update Committee (RUC) that it ignored last year. That means the value of the work relative value units (RVUs) for anesthesia services will go up by 32 percent. Anesthesiologists are the only specialty that stands to see an increase in payments, instead of a decrease, in 2008.

And CMS will adjust the work RVUs for more than 50 procedures, in line with the RUC's recommendations. Work RVUs will go up for 33 codes and decrease for 10 codes, staying the same for another 15. Big winners include 19301 (Partial mastectomy), which goes up from 6.03 work RVUs to 10 work RVUs, and a number of proctosigmoidoscopy codes. Some audiology and cochlear implant codes will go from zero work RVUs to low work RVUs.

Most nursing facility care codes (99304-99310) will see RVU increases. But home visits (99343-99350) will stay the same, instead of increasing as some physicians had requested.

CMS is also revising the way it calculates payments for Part B drugs. Medicare will force drug manufacturers to allocate their "bundled price concessions" when they report the costs of drugs. That may mean you won't lose so much money on drugs because large organizations are getting bulk discounts and driving the average prices down. More important changes in the new proposal include:

Quality: CMS also unveils new quality measures in seven different categories that it wants to include in next year's Physician Quality Reporting Initiative (PQRI). The measures must win the approval of the National Quality Forum (NQF) or the AQA Alliance (AQA) to make it into the PQRI.

The proposed new measures come from the AQA Starter Set, the NQF Ambulatory measure set, and some new measures being developed with the American Medical Association. Medicare will continue to pay bonuses of 1.5-2.0 percent for reporting on quality indicators into 2008.

IVIG: Medicare will keep paying for pre-admission services for intravenous infusion of immunoglobulin (IVIG), using temporary code G0332. This code is designed to reimburse you for the costs and resources involved in tracking down IVIG products for your patients.

Geographic index: CMS also updated its geographic index [...]