Oncology & Hematology Coding Alert

The Medicare payment 'roller coaster ride' isn't over yet.

It's official! President Obama signed the Medicare and Medicaid Extenders Act (MMEA) of 2010 on Dec. 15, 2010. The bill, now law, will eliminate the 25 percent cut that medical practices were going to face effective January 1.

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 Senate Finance Committee noted that MMEA of 2010 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.

The law extends the exceptions process for Medicare therapy caps and extends payment for the technical component of specific pathology services through Dec. 31, 2011. Other effects include a reduction of a beneficiary's liability amount for the Part D "donut hole" and allowing virtually all Medicare beneficiaries to be eligible for free annual wellness visits and many free preventive care services, as well as including other provisions.

According to a Dec. 15 statement by Wilson, "There is bipartisan agreement that the current system is broken, and AMA will work closely with policymakers on a long-term solution that helps physicians continue to care for seniors now and in the future. It's clear that 2011 is the year to finally fix this problem, as the baby boomers begin relying on Medicare this January for their health coverage" (www.ama-assn.org/ama/pub/news/news/obama-signs-medicare-one-year-delay.shtml).

The full text of the bill, which is now law, can be viewed in its entirety at the following link from the White Housewebsite: www.gpo.gov/fdsys/pkg/BILLS-111hr4994enr/pdf/BILLS-111hr4994enr.pdf.

Last minute update: As Oncology and Hematology Coding Alert went to press, Medicare released Transmittal 828 announcing the 2011 conversion factor of 33.9764(www.cms.gov/transmittals/downloads/R828OTN.pdf). This is a decrease from 2010's 36.8729. Recall that payment is based on a number of factors, including multiplying the conversion factor by the relative value units (RVUs) for the particular code.