Pain Management Coding Alert

Question: I haven’t seen or heard much about reimbursement cuts this year. Will there be a change in the conversion factor?

Ohio Subscriber 

Answer: Because the Protecting Access to Medicare Act won’t allow any cuts in the conversion factor through March 31, 2015, CMS has finalized the conversion factor of $35.8013 through that date. Starting April 1, however, you’ll be looking at a conversion factor cut of 21.2 percent through the end of 2015, unless Congress votes to reverse the cut.

“In most prior years, Congress has taken action to avert a large reduction in Physician Fee Schedule rates before they went into effect,” CMS says in a fact sheet about the new fee schedule. “The administration supports legislation to permanently change the sustainable growth rate (SGR) to provide more stability for Medicare beneficiaries and providers while promoting efficient, quality health care.” 

Be prepared: Of course, whether the SGR does get an overhaul in the near future will be anyone’s guess, but with both physicians and CMS supporting a change to it, something might transpire in the coming months.

In addition to the potential 21.2 percent cut, some specialties may see pay cuts whether or not Congress votes to avert that deep discount. Ophthalmologists and dermatologists in particular are expected to see a two percent cut to their Medicare payments, according to the Final Rule. 

Other specialties that could see a positive turn include family practitioners, emergency room physicians, infectious disease providers, physical therapists and internists, who are expected to enjoy a one-percent raise each.