Pulmonology Coding Alert

Dry your tears, because CMS issued a regulation on Feb. 26, 2003, that boosts Medicare payment rates by an average of 1.6 percent beginning March 1.

According to CMS, the change will remove the 4.4 percent decrease in fees that was projected for 2003. The Budget Office even projects a $54 billion increase in physician payments in the next 10 years, says Morgan T. Hause, CCS, CCS-P, privacy/compliance officer at a private practice in Indiana.

This regulation followed legislation approved by the House and Senate weeks earlier that gave CMS the authority to change the formula for the conversion factor for 2003, which stood at 34.5920, Hause says. In response to the congressional action, CMS changed the conversion factor to 36.7856. This is an increase from the 2002 level of 36.20.

According to Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Systems in Lakewood, N.J., any January and February services submitted on March 1 or later will be paid at the new 2003 rate although they are due only the 2002 rate. On July 1, 2003, Medicare will ask you for money to recoup the overpayment of 1.6 percent for the January and February services submitted on March 1 or later. This means your Medicare beneficiaries will pay 1.6 percent too much on their copays.

Cobuzzi recommends holding all the claims you have from January and February that are not submitted by March 1 and submitting them after July 1. All of the new 2003 codes will be paid at the 2003 rates as of March 1 for all dates of service.

CMS also extended the deadline for physicians to decide whether they want to participate in Medicare until April 14, 2003.