Medicare payments: Don't use the 2009 fee schedule!

January 5, 2010

We are receiving a lot of calls and e-mails regarding which Medicare fee schedule dermatology practices are supposed to use starting Jan. 1. There is a lot of incorrect information floating around from various sources.

We are receiving a lot of calls and e-mails regarding which Medicare fee schedule dermatology practices are supposed to use starting Jan. 1. There is a lot of incorrect information floating around from various sources.

Inga Ellzey

On Dec. 16, Congress approved a 60-day temporary fix to the sustainable growth rate (SGR) formula that would have reduced Medicare payments via a new 2010 conversion factor that was 21.29 percent lower than the 2009 conversion factor. This temporary fix suspended the new 2010 conversion factor only, not the fee schedule.

Do not use the 2009 fee schedule!

What are providers supposed to use in 2010?

You will have to check with your local Medicare carriers for a modified/hybrid fee schedule. This new fee schedule will use the already published 2010 RVUs with a slightly tweaked 2009 conversion factor. (The actual conversion factor for January-February 2010 is 36.0846, compared to the 2009 conversion factor of 36.0666). Why they didn’t keep it exactly the same, we’ll never know.

Keep in mind that it would be impossible for providers to utilize the 2009 fee schedule, as there are dozens upon dozens of new CPT and Healthcare Common Procedure Coding System (HCPCS) codes created for 2010 that did not even exist on the 2009 fee schedule. This is currently only a temporary measure that is in effect for the first 60 days of 2010. This, hopefully, will give Congress enough time to devise a more permanent fix.

We received a number of calls from clients stating that the carrier Web sites still show fee schedules with dramatically low fees. That’s because the Web site is probably not updated yet with the new “temporary” fee schedule. Keep checking.

Beware the following myths

1. Providers should continue to use the 2009 fee schedule for the first two months of 2010. This is not true.

2. There will be a delay in the consultation eliminations for the first two months of 2010 because of this temporary fix by Congress. This is not true. The consultation elimination by Medicare is still in effect.

The following information is correct for 2010

1. Providers will use a temporary hybrid fee schedule comprising the 2010 RVUs multiplied by a slightly increased 2009 conversion factor. Check with your local Medicare carrier for a revised fee schedule.

2. The Centers for Medicare and Medicaid Services (CMS) will hold payment on claims for 10 business days (Jan. 15). To give carriers enough time to “catch up,” CMS has instructed the local carriers to hold claims for 10 business days. Due to the strict payment timeframes, this should allow enough time for providers to receive payments before the end of the month.

3. Consultation codes 99241 to 99245 and 99251 to 99255 will no longer be recognized by Medicare in 2010. In lieu of the use of consultation codes, specialists would be required to use the regular “new patient” and “established patient” Evaluation and Management codes for payment purposes, based on the status of the patient with the practice.

IEPG’s DermCoder product

The Inga Ellzey Practice Group mailed the 2010 DermCoder Software just before Christmas. This release already accounted for the temporary fix in the 2010 fee schedule; however, you will need to adjust the conversion factor in the “Setup” screen to reflect the slightly tweaked CF of 36.0846. In addition to all of the new CPT codes, Correct Coding Initiative Rules, ICD-9 codes, V-codes, J-codes and coding rules, we have already accounted for the temporary fix. Should Congress devise a new conversion factor on March 1, users will be able to easily adjust their fees use their existing DermCoder Software.