Medicare Compliance & Reimbursement

The Centers for Medicare & Medicaid Services (CMS) announced that your Medicare payments will drop 10.1 percent in January -- even more than the 9.9-percent cut you were bracing for. Just imagine calculating all your payments with a conversion factor of 34.0682. That's the terrible reality you'll face in January unless Congress acts soon.

"This is disgraceful," says Maxine Lewis with Medical Coding Reimbursement Management in Cincinnati. "Medicare Advantage groups have received an increase," while doctors receive pay cuts. "How does the government believe that a business can operate on a reduction of 10 percent?" she asks.

Doctors may have to limit the number of new Medicare patients they take on if this becomes final, she predicts.

"The legislature has always found a way to not really enforce these expected cuts but this may be the year [a reduction] really happens," warns Marcella Bucknam, manager of compliance education with the University of Washington Physicians.

The looming cut is a good reason to make sure you've mastered the Physicians Quality Reporting Initiative (PQRI) to "get every penny out of the process," adds Bucknam.

The new 2008 physician fee schedule final rule did offer some positive news:

• Your anesthesiologist will be getting a massive pay hike next year. CMS decided to go ahead and increase the work value of almost all anesthesia services by 32 percent.

Tradeoff: A raise for anesthesia means pay cuts for other doctors, notes Bucknam.

Anesthesiologists see a total pay hike of 14 percent next year, but cardiologists, ED doctors, interventional radiologists, neurosurgeons and some other surgeons will all see a 2-percent drop in their payments due to work RVU and practice expense RVU changes.

And because anesthesiologists don't have as much overhead as other doctors, the pay hike may be a little excessive, say some experts.

Anesthesiologists can supervise up to four Certified Registered Nurse Anesthetists, notes Suzan Hvizdash, physician educator for the University of Pittsburgh Physicians Dept. of Surgery.

• CMS is holding off on finalizing most of its controversial Stark self-referral rules. (See related story, "A Reprieve For Many Common Joint Ventures," on page 5.)

Learn more: Go online to http://www.cms.hhs.gov/center/physician.asp to see the new regulation.