2009 Physician Update

Transcription

1 2009 Physician Update CMS E/M Physician Payment Rate The Conversion Factor History PQRI Reporting Electronic Prescribing Medicare New Provider Enrollment New ICD-9 Codes

2 CMS E/M Physician Payment Rates The 2009 physician payment rates for Emergency Medicine services were published by CMS in the Federal Register on November 19th. Very significant changes have taken place regarding the methodology for determining Emergency Physician s reimbursement. The changes have a large impact on Emergency Medicine because both the Conversion Factor (which is the dollar value assigned by Medicare to an RVU), and the number of RVUs assigned for Emergency Medicine evaluation and management (E/M) services were changed for Importantly, the 11.94% budget neutrality factor that was applied to work RVUs in 2008 has been removed. The Conversion Factor History The conversion factor, which is always expressed as a dollar amount, represents Medicare s payment rate for one RVU of physician work. Each year, based on changes to the conversion factor, Medicare, and many private payers, adjust their physician payment rates to coincide with increases or decreases in Medicare s published conversion factor payment. It has long been recognized that the formula used to determine the conversion factor is flawed and outdated. This complex formula is based on the congressionally mandated Sustainable Growth Rate Methodology which each year (based on congressional deficit spending and pharmaceutical pricing) automatically triggers a cut in physician reimbursement by a downward adjustment of the conversion factor. This year s Final Rule published a conversion factor of $ for 2009, a 5% decrease from Taken in isolation this decrease to the conversion factor would lead to a corresponding ~5% decrease in Emergency Medicine reimbursement. However, the 11.94% budget neutrality factor which was previously applied to work RVUs has been removed; this removal is extremely favorable for Emergency Medicine and has helped to actually achieve a net increase in Emergency Medicine reimbursement. Additionally, MIPPA (Medicare Improvement for Patients and Providers Act) of 2008 mandated a 1.1% increase to physician payments. The net result is that Emergency Medicine will see an overall 4+% increase in CMS payments in Conversion Factor The Medicare reimbursement rate for 1 RVU. Historical conversion factor rates: 2000 $ $ $ $ $ $ $ $ $ $ Comparison of 2008 and 2009 RVUs and Payments CPT Code 2008 Total BN RVUs 2008 CMS Pmt 2009 Total RVUs 2009 CMS Pmt % Chg $ $ % $ $ % $ $ % $ $ % $ $ % $ $ % GPCI floor of 1.0 remains in place for rural areas... Alaska is granted a permanent GCPI of 1.5. Maximize your Emergency Department s financial performance using LogixHealth s end-to-end revenue cycle management services.

3 PQRI Reporting The Physician Quality Reporting Initiative (PQRI) program continues in 2009 with a reporting period of January 1, 2009 through December 31, In order to be eligible for a PQRI bonus ED physicians must be successful in reporting greater than 80% of the time on three or more measures. CMS has published 153 PQRI measures for There are seven commonly utilized measures for Emergency Medicine: Four related to pneumonia treatment; EKG for chest pain; EKG for syncope; and Aspirin for acute MI. All of these measures continue to be available for ED physician reporting in Additional measures including several related to stroke care and sterile/optimal central line insertion are also potential ED measures. For 2009 CMS has increased the PQRI bonus by one-third, from 1.5% to 2.0%. Electronic Prescribing There are new incentives for some physicians to utilize electronic prescribing, however these incentives are not applicable to Emergency Medicine. ED physicians (and other hospital based physicians) were perceived by CMS to lack control over implementing electronic prescribing. Additionally, ED patients are from a geographically disparate patient population, and CMS has elected to carve out the ED from the E Rx program and EDs will not be participating. Office-based physicians will be eligible for a small bonus which rapidly transitions to a 2% penalty. Medicare New Provider Enrollment Spelling big trouble for ED groups Medicare has reduced allowable retrospective billing from 27 months to 30 days. Enrollment (855s) for new emergency physicians will have to be submitted as soon as possible. The American Medical Association has released its annual update of the CPT code set for There are very few changes that directly impact Emergency Medicine. Of note, the codes available to report pediatric services have been fully reformatted. However, ED physicians will still utilize the typical 9928x ED codes and 99291/99292 critical care codes to report services provided to ED pediatric patients. For groups involved in providing critical care transport for pediatric patients there is a new set of codes available. Codes have been deleted and the new codes for face to face physician care during critical care transport of pediatric patients 24 months of age or younger are 99466/ Level % Annual Visits Level Pmt Chg Annual Pmt Chg $0.78 $ ,500 $2.75 4, ,400 $ , ,900 $ , ,000 $ , $7.92 7,128 TOTAL , $136,539 ($4.55/visit) Emergency Medicine Reimbursement up 4% PQRI bonus increased to 2% No E Rx for the ED Medicare Limits retroactive billing to 30 days

4 New ICD-9 Codes The Effective October 1, 2008 there are several new sets of useful ICD-9 diagnosis codes. Some of the highlighted codes of interest to Emergency Medicine include: New MRSA codes: Methicillin resistant Staphylococcus aures (MRSA), septicemia Methicillin resistant Staphylococcus aures (MRSA), bacterial infection New headache codes: Cluster headache syndrome, unspecified Tension type headache, unspecified Acute post traumatic headache Chronic post traumatic headache, Other Primary thunderclap headache More specific hematuria codes: Hematuria, unspecified Gross hematuria Microscopic hematuria Greater definition for Stevens-Johnsons Syndrome: Erythema multiforme, unspecified Erythema multiforme minor Erythema multiforme major Stevens-Johnsons Syndrome Other erythema multiforme More accurate fever codes: Fever, unspecified Fever presenting w/ conditions classified elsewhere Post-procedural fever Post-vaccination fever Chills (without fever) For a full list of the 2009 ICD-9 updated codes, please visit the LogixHealth website ( under the Resources section.

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