Practice Management Alert

Every year, practices wait for the Medicare Physician Fee Schedule Final Rule release to find out what to expect for the coming year. The news this year isn't all good. Here's what you need to know about the fee schedule to prepare your practice for potentially negative effects of the 2010 changes.

Get ready for another year of nail biting to find out if your Medicare payments will be slashed. "The update to the physician fee schedule conversion factor is "21.2 percent for CY 2010, notes the 2010 Medicare Physician Fee Schedule Final Rule, printed in the Nov. 25 Federal Register.

Traditionally, Congress has stepped in to reverse such dramatic cuts before they take place, but unless that happens this year, you'll face a conversion factor of $28.4061 effective Jan. 1, according to calculations in the Federal Register.

Many physician practices expressed angst at such low reimbursement rates, with some indicating that they would become non-par with Medicare if the cuts take effect. "Physicians have been getting more disgruntled over the past several years with the threat of cuts, and if their reimbursements are cut by such an egregious amount, this will finally send them over the edge," says Charlene Burgett, MS, CMA (AAMA), CPM, CPC, CMSCS, administrator with North Scottsdale Family Medicine. "It is becoming more and more difficult dealing with all health plans, especially Medicare," Burgett says. "It is not going to be worth accepting Medicare due to the fact that there is more red tape and government bureaucracy with nothing to show for it if there is a reduction in reimbursement."

"Beginning Jan. 1, 2010, we will eliminate the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation G codes) on a budget neutral basis by increasing the work relative value units (RVUs) for new and established office visits" and for initial hospital and initial nursing facility visits, the Final Rule notes. Although CMS has halted payment for the in-office consultation codes (99241-99245, Office consultation for a new or established patient ...) and inpatient consultation codes (99251-99255, Inpatient consultation for a new or established patient ...) in 2010, the AMA chose not to delete them, keeping them in the CPT manual for another year.

Keep in mind: The fact that the consult codes appear in CPT 2010 is no indication of whether payers will actually cover the services next year. Medicare published the final rule on the fee schedule and did adopt the proposal to no longer pay for the consultation codes. Private payers may also follow suit and eliminate consultation payment.

"The problem is that the elimination is only a CMS issue and not a private payer elimination," explains Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J., and senior coder and auditor for The Coding Network. Each payer may decide whether to adopt Medicare's rule. "The AMA has kept consultations in the CPT manual and we will have to manage who does and who does not allow consultation. If you think getting a request for opinion was hard before, this will be worse, since no one knows who will require one, with the only surety being that CMS does not."

What it means to your practice: The elimination of consult codes will hurt specialty practices in particular, says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting and Coding Education.

Practices will have to re-educate physicians, nonphysician providers, coders, CMAs (certified medical assistants), nurses, and secretaries, and will need to revise their encounter forms, says Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind.

Silver lining: CMS will raise payment for the other E/M codes to try and offset the consult loss. For instance, you'll see a 7 percent increase for 99214, with physician work RVUs rising to 1.50 from the 2009 rate of 1.42.However, certain specialists still end up losing money.

Physicians who adopt e-prescription systems are eligible to earn a bonus of two percent of their total Medicare allowed charges, but the rules on how you'll report your e-prescribing will change next year.

Effective Jan. 1, you'll report an e-prescribing code only when a visit results in an electronic prescriptionbeing placed. You'll need to report this code at least 25 times during the reporting period to be considered a successful electronic prescriber.

CMS will issue a new numerator G code with the following descriptor, the Final Rule says:

• Gxxxx -- At least 1 prescription created during the encounter was generated and transmitted electronically using a qualified electronic prescribing system.

More information: You can review the final rule at www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf.