Nothing is as constant as change, especially at this time of year in the world of coding and reimbursement. For example, are you aware of the following new developments?
- Physician Coding: The American Medical Assn.’s CPT 2010 coding manual was shipped to healthcare providers in October. It contains all the new, revised and deleted Level I codes; Category II (performance measurement) codes and Category III (T codes for emerging technology, services and procedures) that become effective Jan. 1, 2010. Now is the time to become familiar with any changes related to procedures that may involve your products.
- Physician Reimbursement: On Oct. 30, 2009, CMS posted its payment and policy changes for the 2010 Physician Fee Schedule (PDF). A copy of this final rule is expected to appear in the Federal Register on Nov. 25, 2009. Due to the required application of the Sustainable Growth Rate (SGR) that was adopted by the Balanced Budget Act of 1997, the 2010 conversion factor will be (-21.2 percent). This means the conversion factor will decrease from $36.0666 to $28.4061 as of Jan. 1, 2010.
This is a dramatic reduction in overall physician reimbursement. Hopefully, Congress will intercede in the coming months. Unfortunately, it was not remedied by the recent Senate debate and not addressed when the House voted to pass healthcare reform Nov. 7, 2009. If this conversion factor is not changed, many more physicians will refuse to take care of Medicare patients.
Other issues in the final 2010 Physician Fee Schedule include an explanation of Medicare’s new methodology to determine Practice Expense Relative Value Units; payment for Anesthesia Services furnished by CRNAs; and of interest to those of you involved in knee arthroscopy, CMS accepted the AMA RUC’s recommendation to include Practice Expense inputs for knee arthroscopy (CPT 29870) in the non-facility setting.
- Hospital Inpatient Reimbursement: For discharges occurring on or after Oct. 1, 2009, acute care hospitals are now receiving reimbursements under Medicare’s Fiscal Year 2010 MS-DRG payment rates. The final Inpatient Prospective Payment System (PDF) rule was published in the Federal Register August 27, 2009. Effective Oct. 1, 2009, Medicare provided hospitals with a 2.1 percent inflation update, or an additional $1.9 billion over FY2009.
- Hospital Outpatient & ASC Reimbursement: Also on Oct. 30, 2009, Medicare posted its payment rate changes for Hospital Outpatient departments (PDF). This final rule is expected to be published in the Federal Register on Nov. 20, 2009. Effective Jan. 1, 2010, most hospitals will receive an inflation update of 2.1 percent in their payment rates for services provided to Medicare patients in their outpatient departments and a 1.2 percent inflation update for services provided in their ambulatory surgery centers. For those with products used in the outpatient setting, you may want to skim the attached final rule.
- FY2011 Proposed ICD-9-CM Procedure Code Changes: It is never too early to consider how future coding changes may impact your product business. If you are involved with a cardiac or spine device company, then you should review the proposed code revisions discussed at the Sept. 16-17, 2009 ICD-9-CM Coordination and Maintenance Committee meeting. Please see pages 26-30 of the attached meeting minutes to appreciate the proposed ICD-9-CM (PDF) coding changes for implementation on Oct. 1, 2010. CMS is accepting comments about these proposed changes until Nov. 20, 2009.
Why is this at all important to busy medical device sales and marketing professionals? Simply put, these coding and reimbursement changes will impact your customers’ decision-making processes in 2010. We hope you’ll use this forum to pose a question and/or share a valuable lesson learned. We look forward to hearing from you.