Watch for these RVU changes to determine your 2012 payments
In case you were hoping for a reprieve in 2012 from the
recession cost stresses on EDs, the word is that you can anticipate an overall
decrease of 1.5 percent in entire 2012 CMS payments. Read this expert medical
coding insight and learn how this all breaks down and will influence your ED
billing.
2012 Medicare Physician Fee Schedule facts: The Centers for
Medicare and Medicaid Services (CMS) released the Medicare Physician Fee
Schedule Final Rule Nov. 1, 2011, which addresses changes to the physician fee schedule,
as well as other significant Medicare Part B payment policies. The rule is
effective beginning Jan. 1, 2012 and was published in the Nov. 28, 2011 Federal
Register.
Look For Small ED E/M RVUs Decreases
As per the Medicare Physician Fee Schedule 2012 final rule,
emergency medicine will involve a -1 percent update to complete RVU values in
2012. This is free of any change to the conversion factor.
The RVUs for ED E/M codes, the governing factor in defining
ED reimbursement, have only second decimal point adjustments predominantly due
to minor changes in practice expense. Of note, the work RVUs have not changed
for 2012 and remain steady at 2011 levels.
See the chart below to compare the precise RVU E/M code
breakdown for 2011 and 2012:
Anticipate More Pay for Initial, Subsequent Observation
The good news is that you can look for large RVU gains for
initial and subsequent observation care services, whereas the same day
observation admit and discharge codes will remain close to the 2011 values.
Prep for Pay Upticks for These ED Procedures
The 2012 RVUs allocated to complex abscess drainage 10061
(Incision and drainage of abscess [e.g. carbuncle, suppurative hidradentits ,
cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complicated
or multiple) will increase by almost 9 percent and the CPR code 92950
(Cardiopulmonary resuscitation [e.g., in cardiac arrest] will experience a 5
percent increase. The intermediate laceration codes had diverse results. Some
of the code work RVUs were reduced marginally and a few of the intermediate
code values were augmented.
Medicare Physician Fee Schedule 2102 Update: Telehealth
Coverage For ED Services Gets Green Light
And more good news for EDs offering telehealth services: CMS
has expanded its telehealth site promotion to cover EDs, which means EDs are
now qualified site for telehealth coverage. The ED was not considered a
qualified site of services previously, but for 2012, Medicare is creating novel
code descriptors for the telehealth codes. The definition is now being expanded
beyond inpatients and includes the emergency department.
The 2012 ED telehealth codes, descriptors, and assigned RVUs
are listed below. The originating site's reimbursement has been increased as
well by 0.6 percent.
