The good news: You may be due for additional reimbursement retroactive to Jan. 1.
The merely OK news: You’ll have to check your claims and ask your Medicare administrative contractor (MAC) for an adjustment.
The not great but could be worse news: You may owe your MAC money on some claims, but it’s just a few cents per claim.
The next quarterly update to the Medicare physician fee schedule includes revisions to the malpractice relative value units (MP) for 822 codes. “The malpractice relative value unit (MP RVU) has been revised for the codes listed below. These MP RVU changes have a minimal impact on the payment,” CMS 100-04, Change Request 11293 states. In addition CMS notes that the changes are effective for dates of service on and after Jan. 1.
Based on our calculations, the average national fee change for the affected services will a $10.63 pay boost. Changes range from an increase of $150.28 for 63197 (Incise spine&cord 2 trx thrc) to a .36 cent cut for four codes: 27035 (Denervation of hip joint), 94012 (Spirmtry w/brnchdil inf-2 yr), 99462 (Sbsq nb em per day hosp) and 94011 (Spirometry up to 2 yrs old).
As is usually the case, your MAC will not check its records to see if you are owed — or if you owe — money. CMS Instruction 11293.3 states “Medicare contractors shall not search their files to retract payment for claims already paid or to retroactively pay claims. However, contractors shall adjust claims brought to their attention.” Keep in mind that the implementation date for the change request is July 1, so you shouldn't expect a response from your MAC before that date.