Medicare payments for anesthesia
and other services, including pain medicine and
critical care, will increase, not decrease, after
all. Effective March 1, 2003, the national average
anesthesia conversion factor is $17.05, and the
general conversion factor is $36.79. The actual
anesthesia conversion factor varies among the 80-plus
Medicare payment localities. The highest is $19.96,
in Manhattan, and the lowest is Puerto Rico’s
$13.88, a 30-percent difference. The lowest conversion
factor in the continental United States is $15.16
for South Dakota.
Table
1 provides the complete list
of geographically adjusted anesthesia conversion
factors.
Michael Scott’s “Washington Report”
column in the
NEWSLETTER and numerous blast
e-mails to the ASA membership have described the
successful efforts of organized medicine and key
players in Congress to bring about this dramatic
cancellation of the 4.4-percent cut announced in
the Physician Fee Schedule Rule on December 31,
2002. The Consolidated Appropriations Resolution
that eliminated the decrease also authorized the
Centers for Medicare & Medicaid Services (CMS)
to correct problems in the formula for calculating
the annual fee schedule update, resulting in a 1.6-percent
increase. As CMS put it in a fact sheet accompanying
the publication of the new conversion factors:
"In developing the final rule,
CMS did everything it could under existing
law to reduce the potential effect of these
payment reductions on physicians. However,
the statutory formula allows little flexibility.
One refinement to the fee schedule methodology
had the effect of benefiting physicians —
changing the measure of productivity in Medicare
Economic Index (MEI), a factor in determining
the sustainable growth rate (SGR).
“CMS believed that the 2003 update would
be more accurate if CMS had the legal authority
to revisit the SGRs for 1998 and 1999, in
light of actual data rather than projections.
These revised SGRs would not be given retroactive
effect but would be used in calculating the
2003 update. CMS estimated that the resulting
update would be a positive 1.6 percent.” |
The fact sheet is a manifestation of CMS’
recent efforts to make its Web site
<www.cms.hhs.gov/>
an easier place to locate information. The Web site
is worth a visit if you are seeking copies of sections
of the
Medicare Carrier Manual, recent
Program Memoranda sent to the carriers, statistics
from the huge database of claims or other Medicare
information.
As we see it, CMS has less reason to be proud of
its decision regarding the undervaluation of the
“physician work” component of anesthesia
services. The
“Practice Management”
column in the February 2003 NEWSLETTER
discussed the agency’s proposal
to increase anesthesia work by just 2.10 percent
despite receipt of data approved by the American
Medical Association/Specialty Society Relative Value
Update Committee (RUC) showing that a 13.57-percent
increase would have been more appropriate. ASA filed
a formal protest and request for reconsideration
with CMS on March 3, 2003.
How Medicare Will Pay
for Services Provided in January and February
The conversion factors for anesthesia and other
services provided in January and February 2003 are
$16.60 and $36.20, respectively (unchanged from
2002). January and February claims received by the
carriers after March 1 will be paid incorrectly
at the higher 2003 rates since the carriers cannot
maintain two separate fee schedules on their systems.
This means that the carriers will be seeking refunds
from physicians starting in July, when CMS will
issue software allowing them to identify overpayment
amounts. Anesthesia and pain medicine practices
that submitted high volumes of claims for services
provided during the first two months in late February
or early March may need to plan to have the repayment
funds available.
Some carriers may have been holding claims because
of the uncertainty, both about the payment amount
and about Current Procedural Terminology™
(CPT) codes that were deleted or added in 2003.
Code changes only became effective for Medicare
purposes on March 1. All carriers are required to
start processing 2003 claims no later than March
10.
You May Change Your Participation
Status Up to April 14
If you decided whether or not to be a participating
physician this year in anticipation of Medicare
payment cuts, you may change your mind and submit
a new participation agreement to your carrier by
April 14, 2003. The effective date of any such new
agreement will be March 1.
The following information appears in CMS’
Questions & Answers section on the 2003 payment
update:
| “Q. If a physician decides not
to participate by April 14, but has been paid
as a participating physician prior to that
decision, will CMS seek to recoup overpayments?
And may the physician bill the beneficiary
retroactively up to the limiting charge?" |
| “A. A participation agreement
filed by April 14, 2003 will be effective
March 1, 2003. If a physician changes his/her
enrollment status after he/she submits March
and early April claims, he/she will need to
contact his/her carrier to request a payment
adjustment for those March and April claims
processed using the pre-March 1 enrollment
status. Carriers will follow the standard
procedures in the Medicare Carriers Manual
for the collection of overpayments from providers
and beneficiaries, as appropriate.”
|
While a 2.7-percent increase is far preferable to
a 3.43-percent decrease in the anesthesia conversion
factor, and a 1.6-percent increase is better than
a 4.4-percent decrease in the general conversion
factor, let us hope that the process of determining
the 2004 Medicare update will entail fewer administrative
complexities.