Pediatric Coding Alert

Many private payers follow these trends, so keep an eye on this issue as the year progresses.

Medical practices are prepping for another year of nail-biting to find out whether Medicare payments will be dramatically reduced--and believe it or not, this could impact pediatricians.

"The calendar year 2012 Physician fee schedule conversion factor is $24.6712," notes the 2012 Medicare Physician fee schedule Final Rule, printed in the Federal Register.

This 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."

All private payers and Medicaid programs in some way utilize the resource-based relative value scale to develop and maintain their fee schedules, so there's a real possibility that private payers will follow suit. Keep an eye on Pediatric Coding Alert for more on this issue as it develops.