is a series of articles culled from the State of Ohio’s
Medicare Part B carrier, Palmetto GBA, announcing that
on December 20, 2006 President Bush signed a bill into law
that reversed a mandated 5.1% DECREASE in the Part B
conversion factor for 2007. Instead, the conversion factor
will be the same as was used in 2006, $37.8975 per RVU.
However, as you will quickly see, that does not mean that
reimbursement in 2007 will be the same for the same CPT
services as in 2006.
2006, Medicare completed a review of their Relative Value
Unit (RVU) factor scale used to value the level of “effort”
expended (the review was last done in 1997). As a result,
many work RVU values for Evaluation and Management (E&M)
services were increased significantly. See the examples
99213 - Level 3 office visit
Work RVU increase of 37%
CPT 99223 - Level 3 (highest) initial hospital visit
Work RVU increase of 26%
CPT 99233 - Mid level subsequent hospital visit
Work RVU increase of 31%
change, when all multiplied through results in the following
increases in reimbursement for these same CPT codes:
99213 – 2007 $57.68 2006 $50.90
increase $6.78 or 13.2%
CPT 99223 – 2007 $170.75 2006 $154.54
increase $16.21 or 10.5%
CPT 99233 – 2007 $89.51 2006 $77.83
increase $11.68 or 15.0%
safe to say that of all the specialties affected with the
changes in 2007, internal medicine physicians will be
smiling the most!
are links to the Palmetto GBA website if you would like to
get the entire fee schedule online. However, below you will
see two schedules for your reference. The first summarizes
the movement in conversion factors over the past seven years
and the second summarizes the movement in fees for the same
CPT code between 2007 and 2006 for our most frequently used
(60 or so) CPT codes.
wishes to all for a Happy New Year and a Healthy 2007.
What You Need to Know About the Tax Relief and Health Care
Act of 2006
This article is based on Change Request (CR) 5448. The Tax
Relief and Health Care Act of 2006 changes the update to the
2007 conversion factor for services paid under the MPFS, and
this change is effective for services provided on or after
January 1, 2007.
The Tax Relief and Health Care Act of 2006 set the 2007
conversion factor for physician payment at the same level as
in 2006 ($37.8975), reversing the statutorily mandated 5.0
percent negative update. However, it does not maintain 2007
physician payments at 2006 levels. There are a number of
other factors that affect payment rates for 2007.
Other changes adopted in the physician fee schedule final
rule that affect 2007 payment rates include changes in the
practice expense RVU-setting methodology, refinements to the
practice expense RVUs, re-weighting of geographic adjustment
factors, limits on payments for imaging services required by
the Deficit Reduction Act, and other annual refinements
including coding changes.
Both the Centers for Medicare & Medicaid Services (CMS) and
your local Medicare contractor will display the resulting
new fees on its Web site no later than December 31, 2006.
The revised fees under the 2007 MPFS will be effective for
services provided on or after January 1, 2007.
change to the 2007 MPFS will also result in an extension of
the participation enrollment period to February 14, 2007.
Therefore, the participation enrollment period runs from
November 15, 2006, through February 14, 2007. The effective
date for any participation change is January 1, 2007.
Physicians who wish to sign an agreement and become
Participating (Par) physicians can access the Par Agreement
(CMS-460 form) from the CD which was mailed to all
physicians last November. Physicians can also request the
CMS-460 form from their local Medicare contractor. Existing
Par physicians who no longer wish to be Par must notify
their Medicare contractor in writing of their decision to
terminate their Par agreement. Physicians who change their
Par status during the extension period should begin to
submit claims based on their new Par status.
Palmetto GBA will
process claims with 2007 dates of service using the new
fee schedules. There will be no delays in processing
claims. We will not hold claims for 2007 dates of
service because the new fees will be available to
process these claims.
Revised fee schedules
for Ohio for
services paid under the MPFS are available at
anticipate that CMS will release an article in the near
future that provides more information about the changes
associated with the Tax Relief and Health Care Act of
2006. Palmetto GBA will publish this article on our Web
site as soon as it becomes available.