Medicare Cuts Seem Inevitable

The center for medicare and medicaid services posted final medicare payment rules on tuesday which include cuts in physician reimbursement rates.

The first medicare payment reduction will be 23.6% Effective december 01, 2010. On january 01, 2011 there will be a further payment reduction of 6.5%. The national conversion factor will decrease from $36.8729 To $28.3868 On december 01, 2010 and decrease further to $25.5217 On january 01, 2011.

As an example code 99213 now pays $66.74 But with the new fee schedule being implemented in january 2011 it is estimated to drop to $51.81. The american medical association as well as other physician associations are currently lobbying for a temporary or permanent payment fix. Please have your staff and patients contact their members of congress to request they intervene to stop these cuts permanently or at least delay them. It can be as easy as sending an email or making a phone call. Click the link below to obtain their contact information.


RAC Audits Simply Defined

RAC Audits are a reality. What is an RAC? An RAC is a Recovery Audit Contractor contracted by the CMS Office of Program Integrity. They completed their demonstration Project in 2005 – 2008 in the states of FL, SC, NY, MA and CA. The result, they recovered more than $450M (Well they had to return some of on appeal…but who’s counting?). Now there is a Permanent RAC Program, which was established in 2009. Look it up at There they list who are the Contractors and what they are looking for specifically in each geographic region they cover. And by the way, each RAC auditor looks at the others to see what they are doing/did and who recovered more money. RACs conduct audits of paid claims and recover improper payments AND identify underpaid claims. They are paid a % of recoveries – No recovery = no commission. MPI is aware of this and track these audit’s “de jour” on-line.


ICD-10 Is coming in 2013 – Don’t Wait!

ANSI 5010 migration is coming in 2012. ICD-10 is coming in 2013. Remember that not all Plans will follow CMS day one with ICD-10. This means that providers will have to maintain usage of ICD-9 while deploying ICD-10 in the practice in 2013. In fact, Worker’s Comp and NYS No-Fault are exempt from ICD-10 requirements.

You need to plan now and put together strategies that migrate your practices in the direction of ICD-10. It is important to understand the costs in loss of productivity as well as in training.

Your Practice Management software should handle the technology piece and guide you on the mechanics, but proper planning and close collaborative effort with your billing service or practice administrator is essential to get it right.

Starting out with delay, doubt, fear or misguided expectations will not achieve the required goal.