2009 Medicare Physician Fee Schedule
Primary Care Benefits From Budget-Neutrality Adjustments
By News Staff
With daily news reports on the state of the weakening economy, some physicians may have missed a glimmer of good news that came with CMS' publication of the 2009 Medicare physician fee schedule.
According to Kent Moore, the AAFP's manager of health care financing and delivery systems, family physicians should see a total increase of about 2 percent for allowed Medicare charges based on changes in the 2009 fee schedule.
One of those changes, mandated by the Medicare Improvements for Patients and Providers Act of 2008, required CMS to change its method of implementing budget-neutrality adjustments.
"Most evaluation and management, or E/M, services, which make up the bulk of family physicians' services, benefited from this change," said Moore.
According to him, using the previous method to estimate payment would have resulted in a payment of $60.98 for CPT code 99213. But with the new method, physicians would earn $61.25 for the same code -- a 0.5 percent increase.
Moore gave another example using CPT code 99233 for initial hospital care. According to his calculations, the change in methodology resulted in a 3 percent payment increase.
"Admittedly, the benefit is not huge, but it is a boost for E/M services," he said.
Although the decision to alter the budget-neutrality adjustment was legislatively mandated and, therefore, not subject to public comment, the AAFP nonetheless took advantage of previous CMS invitations for public comment.
In a 10-page letter about the 2009 fee schedule sent to CMS Acting Administrator Kerry Weems in December, AAFP Board Chair Jim King, M.D., of Selmer, Tenn., commended the agency for a number of its decisions, including
One of those changes, mandated by the Medicare Improvements for Patients and Providers Act of 2008, required CMS to change its method of implementing budget-neutrality adjustments.
"Most evaluation and management, or E/M, services, which make up the bulk of family physicians' services, benefited from this change," said Moore.
According to him, using the previous method to estimate payment would have resulted in a payment of $60.98 for CPT code 99213. But with the new method, physicians would earn $61.25 for the same code -- a 0.5 percent increase.
Moore gave another example using CPT code 99233 for initial hospital care. According to his calculations, the change in methodology resulted in a 3 percent payment increase.
"Admittedly, the benefit is not huge, but it is a boost for E/M services," he said.
Although the decision to alter the budget-neutrality adjustment was legislatively mandated and, therefore, not subject to public comment, the AAFP nonetheless took advantage of previous CMS invitations for public comment.
In a 10-page letter about the 2009 fee schedule sent to CMS Acting Administrator Kerry Weems in December, AAFP Board Chair Jim King, M.D., of Selmer, Tenn., commended the agency for a number of its decisions, including
- supporting the inclusion of clinical staff time for quality activities in direct practice expenses attributable to immunization administration codes;
- doubling the time period -- from 30 days to 60 days -- for physicians to submit all outstanding claims to Medicare after their Medicare privileges have been revoked;
- decreasing the amount of time physicians are required to retain ordering and referral documentation from 10 years to seven years; and
- reinstating the original Jan. 1, 2012, date for the exemption for computer-generated fax transmissions.
However, in the same letter, King also expressed disappointment with a number of CMS decisions, including
- the addition of follow-up inpatient telehealth consultation codes to the Medicare telehealth benefit;
- no action on updating high-cost supplies every two years;
- continuation of carrier pricing for the moderate sedation CPT codes 99143 to 99150, despite an April 2005 recommendation on relative values made by the Relative Value Scale Update Committee; and
- the ability to revoke a physician's Medicare billing privileges without the opportunity for expedited reconsideration whenever a Medicare contractor determines that a practice location is not operational.
Regarding the last point, King pointed out that Medicare contractors serve as the recipients of physicians' Medicare enrollment information, which physicians are obligated to update to reflect practice changes, such as a new practice location. However, contractors often have a 60-day to 90-day backlog of paperwork; that unprocessed paperwork could result in revocation of a physician's billing privileges through no fault of the physician, said King.
King also noted in the letter that, "CMS still seems to underestimate the burden its enrollment process places on physicians and other health care professionals who wish to service Medicare beneficiaries."
King also noted in the letter that, "CMS still seems to underestimate the burden its enrollment process places on physicians and other health care professionals who wish to service Medicare beneficiaries."
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More From AAFP
Family Practice Management: "CPT 2009 -- Out With the Old, In With the New"
(Members/Paid Subscribers Only)
HHS Hikes Value of Mental Health Services in Medicare
Physicians, Patients Stand to Benefit
(7/24/2008)
New, Revised CPT Codes Target Online, Telephone Services
(2/29/2008)
More From AAFP
Family Practice Management: "CPT 2009 -- Out With the Old, In With the New"
(Members/Paid Subscribers Only)
