Urology Coding Alert

You can breathe easier about the Medicare reimburse-ment your practice will be seeing for the remainder of this year, and beyond. Congress ensured a short-term solution to threats of a double-digit Medicare payment decrease.

Background: On July 9, the Senate voted by a veto-proof margin to support the Medicare Improvements for Patients and Providers Act (H.R. 6331). Although the Senate had previously shot down the measure during a June 26 vote, the bill passed the Senate during the second vote. On July 15, President Bush vetoed the bill.

"I support the primary objective of this legislation, to forestall reductions in physician payments," Bush said in a statement. "Yet taking choices away from seniors to pay physicians is wrong."

Later the same day, the House of Representatives voted 383-41 to override it. The Senate followed suit soon after, overriding the veto by a vote of 70-26.

"The medical community got a practical look at 'How a Bill Becomes a Law,'" says Laura Colbert Carbonaro, director of central billing operations for a medical practice in Tarrytown, N.Y. "That enough Republican senators crossed the aisle to vote for this bill demonstrated that they recognized the severe negative impact a rate cut would have had and put that above concerns for the limitations the bill had in other areas such as Medicare Advantage plans."

The new law is retroactive to July 1 -- which means that if your carrier paid any of your claims with dates of service between July 1 and July 14 at lower rates, they're going to owe you money.

Carriers will "automatically reprocess any claims paid at the lower rates," according to a July 16 CMS memo.

In addition to halting the July 1 10.6 percent rate cut and the 5.4 percent cut due on Jan. 1, 2009, the legislation continues the 0.5 percent boost that you received last January and increases the conversion factor an additional 1.1 percent for 2009.

Many physician groups support this change. "It has been a long and winding road, but today we celebrate that Congress heard the voices of millions of patients and physicians and voted to override President Bush's veto and protect the health of America," said Nancy H. Nielsen, MD, president of the American Medical Association, in a statement. "We thank the bipartisan majority in Congress who voted to put patients first."

Downside: This bill is still only a temporary fix for your Medicare payments. Many practices are hoping a long-term fix will come along soon.

"I'm thankful that Congress has stopped the 10.6 percent pay cut and allowed for a small increase next year, but they still have a lot of work to do," Colbert Carbonaro says. "In every recent year there has been an eleventh-hour congressional act to stop Medicare rate cuts, but what really needs to happen is the formulas need to be fixed so that physicians receive fair compensation that is reflective of the current costs to provide medical care. Otherwise, we'll be facing a 20 percent cut in 2010 and waiting for Congress to stop that as well."

Some in Congress agree. "Congress should be em-barrassed to have doctors and seniors come to Washington hat-in-hand every six months or 12 months or 18 months," said Sen. John Cornyn (R-Tex.) in a statement following the vote. Despite supporting the measure, Cornyn noted that physicians need a long-term solution to the growing problem of pay cuts to the Medicare program.