CMS has not only dropped the conversion factor it uses to calculate Medicare payments for this year, but the agency has altered the relative value units (RVUs) for thousands of codes used to pay for physician services.

Medicare billing expert Frank Cohen found 4,094 code groups had reductions in RVUs and 2,364 resulted in a net increases after CMS recently updated the Medicare Physician Fee Schedule database. We're still reviewing the updates, but the changes will have a negative impact for some physicians billing office visits. 

Example: The national payment rate for 99213 (office visit, established) had been $65.67 earlier this year, but will now pay $65.30. 99214 had paid $98.51, but now pays $97.77.

The Senate will not act on a Medicare payment fix before Memorial Day and allow the scheduled 21.2% sustainable growth rate (SGR) cut to go through.

Senate Majority Leader Harry Reid (D-Nev.) said this morning (May 28) they would wait for the House to act before considering the pay fix. The Senate is set to recess for the Memorial Day holiday and will return on June 7.

The temporary fix would replace the cut with a 2.2% increase retroactive to June 1. In 2011, reimbursement rates would increase by 1%. The House will vote on the measure sometime today.

Thanks to members of Congress, enforcement of the Red Flag Rules will not begin on June 1, 2010. In a May 28 press release, the Federal Trade Commission (FTC) announced it would delay enforcement until Dec. 31, 2010. But, enforcement could start sooner.

Congress requested another delay because it is still working on legislation that would limit the scope of the Red Flag Rules. On Oct. 20, 2009, the House of Representatives unanimously passed HR 3763, a bill that would automatically exempt some business from the Red Flag Rules and allow others to request an exemption. The Senate has taken no action on the bill since it went to the Senate's Committee on Banking, Housing, and Urban Affairs on Oct. 21, 2009.

The carrier Palmetto GBA will transition to cover Medicare Administrative Contractor (MAC) Jurisdiction 11, comprised of North Carolina, South Carolina, Virginia and West Virginia, the carrier has confirmed with Part B News.

Palmetto has not said when the transition will begin or when it will be completed. CMS's MAC reform website still shows the Jurisdiction 11 bid contract under protest.

It's worth noting other MAC transitions have not gone so well in previous years. This transition might be more difficult for Part B physician practices in North Carolina and Virginia. Palmetto is already the Part B carrier for South Carolina and West Virginia. But Cigna is the carrier for North Carolina and Trailblazer is the carrier for Virginia.

Some physician practices billing consultation codes (99241-99245, 99251-99255) to private payers running Medicare Advantage plans have recently reported receiving denials.

After CMS eliminated the codes Jan. 1, private payers could choose to continue reimbursing the codes or follow CMS's lead.

At first, most continued accepting the codes. But practice management consultants recommended that practices try to keep up with policy updates from payers contracted with the practice. Several payers - such as Humana, UnitedHealthcare and Anthem (pdfs) - have since said they will no longer accept consult codes.

Practices also must monitor denials. Receiving a denial for using a consult code is another way to learn a payer no longer accepts the codes (although it's finding out the hard way).

Have you come across private payers no longer taking consult codes? If so, who?