Even though the SGR will not be implemented until January 1, 2012 the conversion factor for Medicare will go down. The reason for this is somewhat complex in calculation. We will attempt an abbreviated summation here.
In the final rule for 2010 the included changes to budget neutrality that in turn affected the SGR formula calculation. Two major factors in the is change seem to have provided the biggest impact. First drugs administered by the physician were removed from the SGR calculation. The removal of these drugs did help with raise the conversion factor for 2010.
The second change requires the index for inflation be changed from the Consumer Price Index (CPI) to the Medical Economic Index (MEI). The Center for Medicare and Medicaid Services (CMS) elected to apply the rebased MEI calculation to the Practice Expense (PE) and the Mal-practice Expense (MP) values. The net effect of these changes for Urology is a bump in the total values for many of the services that are provided. Some of you may recall that last year a number of services provided in the physician office went down even though the conversion factor remained steady from January to June and was raised by 2.2% for services provided between June 1 and November 30. The decreases in fees for UDS, TUMT, Laser and many in office procedures was directly effected by the phase in the new methodology for the calculation.
Even though the SGR will not be implemented until January 1, 2012 the conversion factor for Medicare will go down.
The reason for this is somewhat complex in calculation. We will attempt an abbreviated summation here.
In the final rule for 2010 the included changes to budget neutrality that in turn affected the SGR formula calculation.
Two major factors in the is change seem to have provided the biggest impact.
First drugs administered by the physician were removed from the SGR calculation.
The removal of these drugs did help with raise the conversion factor for 2010.
The second change requires the index for inflation be changed from the Consumer Price Index (CPI) to the Medical Economic Index (MEI).
The Center for Medicare and Medicaid Services (CMS) elected to apply the rebased MEI calculation to the Practice Expense (PE) and the Mal-practice Expense (MP) values.
The net effect of these changes for Urology is a bump in the total values for many of the services that are provided. Some of you may recall that last year a number of services provided in the physician office went down even though the conversion factor remained steady from January to June and was raised by 2.2% for services provided between June 1 and November 30.
The decreases in fees for UDS, TUMT, Laser and many other in office procedures was directly effected by the phase in the new methodology for the calculation.
New values for a few of these services are listed below with the percentage change.
|
Code
|
Description
|
Total NF Value 2010
|
Total NF Value 2011
|
% Change
|
|
52204
|
Cysto Biopsy
|
11.85
|
12.54
|
5.82%
|
|
52214
|
Cysto Fulguration
|
16.53
|
18.72
|
13.25%
|
|
52224
|
TURBT small
|
21.61
|
22.38
|
3.56%
|
|
52648
|
Laser Prostate
|
62.79
|
59.31
|
5.87%
|
|
53850
|
TUMT
|
65.90
|
69.44
|
5.37%
|
|
96402
|
LHRH Admin
|
0.97
|
1.04
|
7.22%
|
|
99214
|
Est. E/M
|
|
3.02
|
|
The slight bump in Relative Values coupled with the budget neutrality adjustment have Medicare projecting losses for Urology of -3% for 2011 if the SGR is once again delayed.
We are often asked if the SGR will be delayed. In our discussions we both have had to admit we are worried. In the past the discussions have all centered around the delay in the SGR have been when and not if the delay will be inacted.
The politics now include a lame duck session of congress that was “unelected” in part to do health care reform and an upcoming group with a split message and a vow not to compromise. Hold on to your hats and prepare for a bumpy cash flow at the least.
Self-referral
Many of you have read or heard about new self-referral requirements for services that require the use of equipment that is owned in whole or in part by the referring physician. These rules will go into effect with few changes from the proposed rule in June.
The interpretation we are being provided states that you will be required to notify your patients of at least 5 treatment areas within a 25 mile radius where the patient can also receive the same service. The final rule does not include a proposed rule to require the patient’s signature they received this list of alternative choices.
Make certain that you are compliant and follow the rule of the requirement. The requirement does not state that you are required to list the 5 closest alternative sites, simply that you list 5 alternatives if that many are with in a 25 mile radius of your practice.
Other notes
New codes for PTNS and Micro-radiofrequency treatment for incontinence have been added and valued.
Please check your auacodingtoday.com website for up to the minute changes in fees for 2011 Medicare for these and other services.
We close with this thought. Contact your congressman and give to Uropac, we need the help of Congress to avoid a deep cut in a significant portion of Urology revenue.
