Otolaryngology Coding Alert

However, don’t assume your HPSA bonus will continue.

As many practices are aware, medical offices nationwide were waiting to find out whether legislators halted a 26.5 percent pay cut that the 2013 Fee Schedule predicted, which would have brought the 2013 conversion factor down to $25.0008. In addition, practices were facing a two percent across-the-board sequestration cut that was set to hit Medicare providers’ payment rates in early 2013. This would have impacted even non-Medicare practices since many private payers take Medicare’s lead when setting rates.

Good news: On Jan. 1, Congress voted on the Middle Class Tax Relief Act, which reversed the 26.5 percent cut and froze Medicare payment rates at the 2012 level through Dec. 31, 2013. The bill also deferred the sequestration cuts for two months. A new conversion factor for 2013 was fixed at $34.0230.

Although medical associations were relieved about the continuing Medicare payments for 2013, they lamented the fact that the government had not permanently fixed the problem by overhauling the sustainable growth rate (SGR) formula.

"This patch temporarily alleviates the problem, but Congress’ work is not complete," said AMA president Jeremy Lazarus in a statement. "It has simply delayed this massive, unsustainable cut for one year. Over the next months, it must act to eliminate this ongoing problem once and for all."

"The conversion rate from 2012 will now apply to the 2013 CPT^® relative values for each code," explains Barbara J. Cobuzzi, MBA, CPC, CENTC, CPCH, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. "Please check your Medicare MAC’s website and make sure it has been updated to reflect this change as of the January 1st congressional vote. Your encoder, such as Codify, will be reflecting this continuation of the 2012 conversion factor. Note that the fees from 2012 will not necessarily be the same in 2013 as the RVUs for many CPT^® codes have changed. So, although the conversion factor has remained almost the same, the RVUs have to be considered a variable in calculating the 2013 fees. Make sure you update your practice management software to reflect the new 2013 fees."

Continued HPSA Bonuses Aren’t Guaranteed

If you’ve been enjoying bonuses due to your location in a healthcare professional shortage area (HPSA), check the CMS Web site before assuming that bonuses will carry over to 2013.

"The CMS physician bonus is paid to physicians who are in geographic HPSAs designated as of December 31 of the prior year," said CMS’s Corinne Axelrod during the call. "Eligibility is determined every year. If you were eligible during 2012, you may not be eligible in 2013, and if you weren’t eligible in 2012 you may be eligible in 2013," she added.

To determine whether your area is designated as a geographic primary care HPSA as of December 31, check the CMS Web site at http://bhpr.hrsa.gov/shortage/shortageareas/index.html.

"We do publish a list on our site of areas eligible to receive the bonus automatically (without adding a modifier)," Axelrod said. "If you are eligible for the bonus but not on that list, you’ll need to use the modifier on your claims," she added, referring to modifier AQ (Services provided in a Health Professional Shortage Area [HPSA]). "Only use the modifier in 2013 if you’re furnishing services in an area designated as a geographic HPSA as of December 31, 2012."

For more information on the HPSA bonuses, visit http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/.