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CMS Releases Final Rule for 2010 Medicare Physician Fee Schedule
PINECREST, FL, NOVEMBER 3, 2009 - On October 30th, 2009, CMS released the final rule for the 2010 Medicare physician fee schedule. Of prime importance to emergency medicine are an overall reduction of 2010 physician fees of 21%, and a small increase in relative value units for emergency service CPT Codes 99281 through 99285.
SGR-related Overall Payment Reduction: As in past years, Medicare Part B expenses have exceeded SGR targets, leading CMS to publish a formulaic reduction in the conversion factor used in the physician fee schedule. Unless altered by Congress, the conversion factor will decrease by 21% in 2010. In recent past years, Congress has provided 1-year fixes to the SGR-related fee schedule reductions. It remains to be seen whether Congress will once again cancel the scheduled fee reduction.
Practice Expense Relative Value Unit Increase: For 2010, CMS has incorporated new practice expense data into the Medicare physician fee schedule by revising the RVUs for the practice expense portion of the RBRVS formula. The AMA, through a new multi-specialty survey of practice expenses, supplied CMS with revised practice expense data. Based on this new data, emergency medicine is projected to realize a 2% increase in payments over 2009, to be transitioned in over the next few years.
The following table reflects the Practice Expense RVU and Total RVU for the six Evaluation and Management codes used most frequently in emergency medicine.
| CPT Code |
2009 RVU-PE |
2010 Transitional
RVU-PE |
2009 Total RVU |
2010 Total RVU |
| 99281 |
0.09 |
0.10 |
0.56 |
0.58 |
| 99282 |
0.17 |
0.19 |
1.09 |
1.12 |
| 99283 |
0.27 |
0.29 |
1.70 |
1.71 |
| 99284 |
0.47 |
0.50 |
3.17 |
3.21 |
| 99285 |
0.69 |
0.72 |
4.72 |
4.74 |
| 99291 |
1.17 |
1.24 |
5.88 |
5.88 |
Other changes in the final rule that may affect emergency medicine include elimination of reimbursement for consultative evaluation and management codes, changes to geographic cost indices, and addition of PQRI reporting categories.
To view the complete final rule, visit http://federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf.
BSA Healthcare helps emergency medicine groups maximize their revenue in a compliant fashion. For more information on the final rule or BSA Healthcare's services, please call Jeffrey Bettinger, M.D., FACEP at 305-860-3098, or email Dr. Bettinger at jbettinger@bsanda.com.
About Bettinger, Stimler, Schultz & Associates
Bettinger, Stimler, Schultz & Associates (BSA Healthcare) is a physician-owned healthcare consulting firm that helps
hospitals, academic medical centers, private medical practices, and outpatient facilities improve quality, financial performance,
operations, organizational structure, and strategic direction.
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