Urology Coding Alert

CMS Has a Change of Heart on Proposed Mass Adjustment

Good news for your practice: Urologists won't have to cough up overpayments arising from the delayed implementation of the 2003 Medicare Physician Fee Schedule .
 
CMS had planned to require carriers to collect overpayments from urologists relating to certain claims for services provided in January and February. The problem arose from the delay in the fee schedule's effective date - which was March 1, 2003, rather than Jan. 1. Claims with dates of service in January or February were supposed to be paid at 2002 rates - but due to claims processing limitations, if they were processed or submitted after March 1, they were paid at the higher 2003 rates.
 
CMS had planned to go after those so-called overpayments in a "mass adjustment" in July and has been warning about this move for months. But much to the relief of urologists and other physicians, the agency has had an 11th-hour change of heart.

"If an overpayment exists, you will not be receiving any 'Demand' letters related to an incorrect payment based on the delay of the 2003 MPFS," CMS tells physicians. "This also means that Medicare beneficiaries will not be receiving copies of those 'Demand' letters that would have potentially caused unnecessary confusion to them."
 
To see CMS' notice on the mass adjustments, go to http://cms.hhs.gov/physicians/goodnews.pdf.
 
Note: CMS adds an important caveat to its mass adjustment notice: "You should be aware ... that if you bring to the attention of the Medicare carrier that an incorrect overpayment for January or February 2003 was received, the carrier will still process such an adjustment." Mum's the word.
 
On the other hand, you should appeal incorrect underpayments made when claims for services in January or February were processed after March 1, 2003, such as for the minimally invasive procedures for BPH (53850 for transurethral destruction of prostate tissue by microwave thermotherapy, 53852 for transurethral destruction of prostate tissue by radiofrequency thermotherapy, and 52647 for non-contact laser coagulation of the prostate), to recoup the often substantial differential in payments for these services. Code 53852 pays 27 percent less in 2003 than in 2002.