Neurology & Pain Management Coding Alert

New legislation helps you avoid the scheduled 25 percent drop in Medicare pay for 2011.

The roller coaster ride of conversion factor changes for 2011 has ended, thanks to a Senate Finance Committee bill that will freeze Medicare pay at current levels for another 12 months.

The House of Representatives passed the Medicare and Medicaid Extenders Act of 2010 on Dec. 9 and the Senate voted on it the day before. The bill will eliminate the 25 percent cut that medical practices were going to face effective January 1. President Obama made it official on December 15, 2010, when he signed the year-long delay into law.

Physicians cheered the news that they won't have to wait for the new Congress and Senate members to take their seats before determining whether a payment fix would take place. "The AMA welcomes bipartisan House passage of legislation to stop the Medicare physician payment cut for one year," said AMA president Cecil B. Wilson, MD, in a statement on Dec. 9. "Stopping the steep 25 percent Medicare cut for one year was vital to preserve seniors' access to physician care in 2011. Many physicians made clear that this year's roller coaster ride, caused by five delays of this year's cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could treat."

The bill passed as a bipartisan effort, and the Senate Finance Committee noted that it will cost $14.9 billion over ten years to implement the physician pay fix. It will be funded by making minor adjustments to the Affordable Care Act, the health care legislation that President Obama signed into law last March.

Last-Minute Fix Is a Welcome Sight -- But Not Forever

The U.S. Senate passed a quick, one-month extension of the current SGR formula on November 18 in a first step to avoid the 23 percent payment cut physicians were facing on December 1. The House of Representatives had already recessed for Thanksgiving at that point and took up the onemonth fix when they returned on November 29.

"While I am pleased that the Senate has acted swiftly on the pending payment cut and the House is expected to act upon its return from the Thanksgiving break, I remain concerned about another round of short term fixes," ASA President Mark Warner, MD, noted in a published statement at the time. "I hope that the ultimate result of this Congressional session will be a fix of at least one year. This extended period must then be followed by a strong bipartisan commitment from Congress to work with the physician community to finally replace the badly flawed SGR formula with a new update mechanism that works," he added. "The frequent disruptions and delayed payments caused by the current formula and Congress' inability to fix it except for short periods are simply unfair to our members who have payrolls and other practice management expenses."

Check Whether ACF Applies

Some pain management coders also code for anesthesia procedures, which means you have a second CF to consider: the anesthesia conversion factor, or ACF.

The 2011 national ACF will remain at $21.5696. Check your specific area, however, because anesthesia reimbursement varies from state to state --" and even within regions of the same state.

Example: Information from TrailBlazer Health Enterprises lists ACFs in Texas ranging from $21.51 to $22.36 for participating physicians and $20.43 to $21.24 for non-participating physicians.

How the ACF works: The ACF comes into play when you report anesthesia services. Multiply the procedure's base units by the ACF, then add the appropriate number of time units for your total reimbursement. The area's cost of living, insurance expenses, business expenses and other factors combine to create your local ACF, which means the ACF varies from one state to another.

If you code for both anesthesia and pain management, watch your details. Be sure to calculate your providers' expected allowance based on the correct factor to ensure accurate payment.

Resource: Find the full text of the legislation on the Senate Finance Committee's Web page at http://finance.senate.gov/legislation/.