CMS Releases Revised Fee Schedule RVU Files & Conversion Factors
By: Bellinger P. Moody, RHIA, CPC, CPC-I, CCP, Executive Vice President of Compliance
1/6/2011

On December 8, 2011, Congress passed the Medicare and Medicaid Extenders Act of 2010, which blocked the Sustainable Growth Rate (SGR) cut and froze Medicare payments at 2010 levels throughout 2011 – with the exception of changes resulting from the PPACA (Patient Protection and Affordable Care Act) and the MEI (Medicare Economic Index).  According to a recent MGMA Washington Connexion newsletter issued on Wednesday, January 5, 2011, CMS has released updated Relative Value Unit (RVU) files, anesthesia conversion factors, non-anesthesia (general) conversion factor and the updated Medicare physician fee schedule on its website: http://www.cms.gov/PhysicianFeeSched/PFSRVF/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=2&sortOrder=descending&itemID=CMS1242727&intNumPerPage=10

In this update, CMS lists the 2011 anesthesia conversion factors (attached) and the non-anesthesia (general)   conversion factor of $33.9764. This is a decrease of approximately $2.90 from last year’s general conversion factor of $36.88. According to the MGMA Washington Connexion alert, the anesthesia conversion factor and the general conversion factor were modified as a result of changes to the Medicare Economic Index (MEI) as outlined in the 2011 final Medicare physician fee schedule database and as result of adjustments required by the Affordable Care Act: http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

These modifications resulted in a decreased general conversion factor, increased practice expense RVU, increased malpractice RVUs, and lower work values for chronic pain services and critical care services that will result in decreases to fees for many of these services.  The negative impact of these decreases for pain practices and critical care services is about 8%.  

Additionally, the anesthesia conversion factors for all localities (except Miami, Florida – which will remain the same and Queens, NY locality – which actually increased by 12 cents) have decreased slightly from 2010 to 2011. The average decrease in anesthesia conversion factors for those localities with decreases is approximately $0.54.

What does all of this mean for your practice?

Although, the big 25% Medicare fee schedule reduction was averted, calendar year 2011 will bring lower Medicare payments (although very minor) for anesthesia services as well as chronic pain and critical care services.  Due to the PPACA (Patient Protection and Affordable Care Act) and the Medical Economic Index, you will experience a minor decrease in the anesthesia conversion factor that will result in small reductions in reimbursement, but nowhere near the magnitude of what was expected earlier last year.  We will keep you informed of any additional changes to the fee schedule that may impact your revenues.

The information presented herein reflects general information that is current as of the date it was first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.