Pathology/Lab Coding Alert

The RVUs aren’t all you need to observe.

As it turns out, things weren’t settled when CMS published the Medicare Physician Fee Schedule Final Rule in November last year.

Now you’ll need to pay attention to changes in payment and claims processing if you don’t want to face confusion as you bill for your lab services in 2015.

Do this: Just read the following updates, and you’ll have everything you need to understand your Medicare pay — for now.

Your Claims Should Be Moving Again

You may have noticed that your early-January Medicare claims went nowhere fast. That’s because CMS asked MACs to hold all claims with dates of service Jan. 1 through Jan. 14 in order to implement corrections to technical errors discovered after the publication of the rule, said CMS’s Louisa Rink during a Jan. 7 CMS Open Door Forum.

Good news: The hold should have had minimal impact on your cash flow because, “under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt,” Rink said.

Check These Payment Changes

One of the issues with the fee schedule published Nov. 30 appears to have been an error in the conversion factor, said CMS’s Kathy Bryant during the Jan. 7 Open Door Forum. “The conversion factor that is in the new payment files is slightly lower than the conversion factor [CF] in the final rule,” she said. The new CF is 35.7547, which is a change of 0.0466 from the rate published in the Federal Register.

This change, of course, will only impact the conversion factor through March 31. Starting April 1, you’ll be looking at a conversion factor cut of 21 percent (down to $28.2239) through the end of 2015 unless Congress votes to reverse the cut.

Some RVUs changed, too: Some of the technical errors in the published final rule involved RVUs for certain services. Although most lab and pathology procedure RVUs appear unchanged, or only slightly changed, at least one procedure looks much better in the update. The corrected fee schedule revised the RVUs for 88348 (Electron microscopy, diagnostic) from 5.88 to 9.70. Along with the CF change, that means you can now expect $346.82 for the global electron microscopy service instead of $210.51 under the originally-published fee schedule.