Urology Coding Alert

The wait-and-worry game starts now.

Get ready for another year of nail-biting to find out whether your Medicare payments will be dramatically reduced. "The calendar year 2012 Physician fee schedule conversion factor is $24.6712," notes the Physician 2012 Medicare fee schedule Final Rule, printed in the Federal Register that was published on Nov. 1.

This amounts to a dismal 27.4 percent cut compared to the current rate of $33.9764. Here are the details you need to know to start bracing for the looming cuts.

Hope that Congress Steps in to Alter Cuts

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."

As most practices know, last December, Congress voted to not only stave off a 25 percent cut to your Medicare payments but also kept the cuts at bay through Dec. 31 of this year -- and that date is right around the corner. Unless Congress intervenes to reverse the cuts effective Jan. 1, 2012 your Medicare pay is set to drop again based on the new 2012 Fee Schedule information.

Experts lament: Physician advocacy organizations were quick to decry the cuts. "Payments for Medicare physician services have fallen so far below increases in medical practice costs that there is a 20 percent gap between Medicare payment updates and the cost of caring for seniors," said AMA president Peter W. Carmel, MD, in a Nov. 1 statement.

Even CMS officials agreed that the 27.4 percent cut would be devastating, but remained hopeful that the government might rectify the situation before the pay cuts kick in. "This payment rate cut would have dire consequences that should not be allowed to happen," said CMS administrator Donald Berwick, MD, in a Nov. 1 statement. "We need a permanent SGR fix to solve this problem once and for all. That's why the President's Budget and his Plan for Economic Growth and Deficit Reduction call for permanent, fiscally responsible reform and why we are committed to working with the Congress to achieve a permanent and sustainable fix."

The complete Fee Schedule will be posted in the Nov. 28 Federal Register, but is being published online ahead of print for a limited time at www.ofr.gov/%28X%281%29S%28ytexwtdftdqyv0r35jiuojpv%29%29/OFRUpload/OFRData/2011-28597_PI.pdf