I was hoping that by the time I wrote this, there would be some long-term clarity on Medicare’s Physician Payment Schedule for 2012 and beyond.
Unfortunately, there isn’t. Here is what we know so far…
On December 23, all physicians—including optometrists—got a brief reprieve from a 27% Medicare pay cut scheduled to go into effect on January 1, because the U.S. House of Representatives reached an agreement with the Senate on a two-month extension of important policies. The Sustainable Growth Rate (SGR) cut to physicians servicing Medicare payments is not going to happen, at least for another month or so, because the current fee structure will remain in place until the end of February 2012.
A House-Senate conference committee convenes this month to work on a longer-term agreement. However, this will not happen quickly because the House isn’t scheduled to return to Washington until January 17, while the Senate won’t return until January 23. The goal is to extend all the expiring programs for a full year—except for the physician payment cut reprieve, which is to be extended for two years until a better long-term solution can be found.
Additionally, the Centers for Medicare & Medicaid Services (CMS) have extended the annual Medicare participation enrollment period through February 14. The previous deadline was December 31. The effective date for any participation status change during the extension, however, remains January 1, and will be enforced for the entire year. According to CMS, contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are post-marked on or before February 14.
The Good and The Bad
On January 1, the relative values (RVU
s) for many codes commonly used by optometrists to report the physician services they provide to Medicare patients were scheduled to increase. However, these increases will not be realized on January 1 because of the 0% carry-forward of the existing fee schedule. CMS could not put into effect only the changes in RVUs without incorporating the entire impact of the SGR formula, and that meant taking the 27.4% cut as well.
The professional political organizations, such as the American Medical Association and American Optometric Association, are advocating their members to urge Congress and the President to support doctors and patients by providing stability to the Medicare physician payment system.
The threatened cut must be corrected without any further delays and a bipartisan initiative to repeal the flawed and disruptive SGR formula that is causing this crisis should be put in place.
The AOA is specifically requesting doctors and students to support the AOA’s direct advocacy efforts on Capitol Hill by contacting their Senators and House members through AOA’s Online Legislative Action Center ( http://app1.vocusgr.com/WebPublish/Controller.aspx?SiteName= AOAGR&Definition=Issues& Juris=US).
More To Come
2012 should prove to be an interesting year with concerns about E-prescribing penalties, PQRS incentives, audit concerns, new CPT and ICD-9 codes just to name a few. I look forward to keeping all of you informed and engaged.
Don’t forget to send your questions and comments to CodingAbstract@gmail.com.
Clinical Coding Committee
• John Rumpakis, O.D., M.B.A.,
Clinical Coding Editor
• Joe DeLoach, O.D.
• Rebecca Wartman, O.D.
