April 03, 2012
Updated Information About 2011 and 2012 Medicare Anesthesia Conversion Factor
ASA wants to alert members to recent events about the Medicare anesthesia conversion factor (CF). In mid-March, the Centers for Medicare & Medicaid Services (CMS) issued a revision to the CF. ASA posted notice on our website with the new locale-specific CFs. The change was positive; the unadjusted CF increased to $21.52 and the locale-specific CFs increases ranged from $0.08 to $0.13 per unit. While any increase is good news, the limited number of involved claims (January 1 through March 1, 2012) meant that each group would have to make its own determination as to whether incurring the administrative costs associated with requesting re-processing was in its best interest.
ASA followed up with CMS to get the background. During a call on March 29, we learned that the change corrects an error CMS made in determining the CF. Due to a change in their procedures, the practice expense component of the CF did not include the inputs that represent scheduling/case assignment/coordination/form completion activities associated with each anesthesia code. It was during this call that CMS disclosed that the error originated with the 2011 CF and was carried over into 2012. This additional information may change the picture for groups as they determine whether to request reprocessing as the number of impacted claims has increased. The 2011 CF increased to $21.09 with locale- specific increases ranging from $0.03 to $0.07 per unit. We also pointed out during the call that in December 2010 we discussed with CMS staff our concerns about the calculations behind the 2011 CF because we were never able to replicate their work and arrive at the same figures they did.
CMS has posted information on its website. (View Medicare Learning Network Matters MM7745 and CMS Manual System Transmittal 2429 on Claims Processing).
As stated in the CMS materials, instructions for those who want their claims reprocessed are:
"CMS is correcting payments for all anesthesia codes for CY 2011 and for the first part of CY 2012. New Anesthesia Conversion Factor files will be made available for CY 2011 and CY 2012 as part of this change request. Practitioners may elect to have payments adjusted on claims for anesthesia services where the provided service dates fall between January 1, 2012, and March 1, 2012. The new 2012 Anesthesia Conversion Factor file is to be use to adjust these payments, and it is the same file to be used to calculate anesthesia claims for the rest of the 2012 calendar year (file effective date from January 1, 2012, to December 31, 2012). Contractors have been previously directed to start processing anesthesia claims with the revised 2012 Anesthesia Conversion Factor file, with dates of service, March 1, 2012, and forward. Practitioners may elect to have payments adjusted on claims for anesthesia services, where the provided service dates fall between January 1, 2011, and December 31, 2011. The new 2011 Anesthesia Conversion Factor file is to be use to adjust these CY2011 payments (file effective date from January 1, 2011, to December 31, 2011). Practitioners should contact their local carrier and bring to their attention these anesthesia payment adjustments, noting that the corrected conversion factors are different for the CY 2011 and CY 2012."