Ophthalmology and Optometry Coding Alert

Could a reprieve be around the corner?

'Tis the season for another round of tense waiting to see if you'll get a dramatic reduction in 2012 Medicare payments for your general surgical services. "The calendar year 2012 Physician fee schedule [PFS] conversion factor is $24.6712," notes the Physician 2012 Medicare fee schedule Final Rule, printed in the Nov. 28 Federal Register -- and that could mean a big cut in your pay.

Look for Congressional Relief

The conversion factor (CF), scheduled to go into effect Jan. 1, 2012, amounts to a dismal 27.4 percent cut compared to the current rate of $33.9764. CMS acknowledges that this massive cut may not be set in stone, stating, "While Congress has provided temporary relief from these reductions every year since 2003, a long-term solution is critical. We will continue to work with Congress to fix this untenable situation so doctors and beneficiaries no longer have to worry about the stability and adequacy of their payments from Medicare under the Physician Fee Schedule."

Physician advocacy organizations were quick to decry the cuts. "Payments for Medicare physician services have fallen so far below increases in medical practice costs that there is a 20 percent gap between Medicare payment updates and the cost of caring for seniors," said AMA president Peter W. Carmel, MD, in a Nov. 1 statement.

Even CMS officials agreed that the 27.4 percent cut would be devastating, but remained hopeful that the government might rectify the situation before the pay cuts kick in. "This payment rate cut would have dire consequences that should not be allowed to happen," said CMS administrator Donald Berwick, MD, in a Nov. 1 statement. "We need a permanent SGR fix to solve this problem once and for all. That's why the President's Budget and his Plan for Economic Growth and Deficit Reduction call for permanent, fiscally responsible reform and why we are committed to working with the Congress to achieve a permanent and sustainable fix."

Recall 2011 fix: Last December, Congress voted to stave off a 25 percent cut to your Medicare pay. But that vote kept the cuts at bay only through December 31 of 2011. Effective January 1, 2012, your Medicare pay is set to drop again based on the new 2012 Fee Schedule information, unless Congress intervenes to reverse the cuts.

Temporary reprieve: On December 23, 2011, President Obama signed into law the "Temporary Payroll Tax Cut Continuation Act of 2011," which delays the proposed 27 percent cut for two months. We'll keep you updated as the latest news becomes available.