Ophthalmology and Optometry Coding Alert

Good news: Expect a boost in E/M reimbursement despite blanket cuts

Your Medicare reimbursement could take a sharp dive next January, especially if you perform any imaging services. The Centers for Medicare & Medicaid Services roared ahead with several controversial proposals in the final regulation for the physician fee schedule, including:

• A 5.0 percent cut to your conversion factor (down from 5.1 in the proposal)

• A cap on the technical component of imaging services at the hospital outpatient rate

• Sweeping changes to practice-expense relative value units (RVUs), phased in over four years

• An across-the-board cut to work RVUs to pay for sharp increases in work RVUs for some evaluation and  management codes.

Deaf ears: Physician associations had asked CMS to revise or delay some of these changes, to no avail. Also, many physician societies had asked CMS to replace the cut to work RVUs with a cut to the overall conversion factor, to spread out the pain. But CMS went ahead with the work RVU cut.

CMS accepted all 400 of the Relative Value Unit Update Committee (RUC) recommendations for changing the RVUs of codes. CMS also went ahead with 150 of its own recommendations, acting deputy administrator Herb Kuhn told a conference call with reporters.

Bright side: You should still notice some pretty "powerful" increases in your reimbursement for mid-level E/M codes, in spite of the cut to the conversion factor and the across-the-board reduction in work RVUs, Kuhn promised.