Ten Years And Counting

Alta Partners, LLC celebrated its ten year anniversary on December 1, 2010.  The employees of Alta, surprised Dan and Stan with an after work celebration at Panini’s in Westlake.  The evening included a presentation of a memory book comprised of employee memories of the last ten years and a collage of all the Alta Partners shirts that have been printed.  The employees worked hard planning this celebration for over a year with secret fundraisers and raffles in order to raise the money necessary for the event and gifts.

Alta Partners would like to thank all of our clients that have made this such an enjoyable adventure.  We look forward to the next ten years of working to provide our clients with the services they need and request. 

Speaking of our clients, did you know Alta Partners has been successful at increasing our business by 327% since December 1, 2000.  The chart below outlines our growth over the last 10 years.

CMS Revised 2011 Conversion Factor

On December 28, 2010 CMS released the revised 2011 conversion factor and updated RBRVS reimbursement table. The conversion factor for 2011 decreases from $36.8729 to $33.9764 a decrease of 2.897 or 7.86%. 

This decrease is attributed to the new cost survey CMS uses to establish practice expense and malpractice RVU’s.  Historically, CMS has utilized the Clinical Practice Expert Panel and AMA’s Socioeconomic Monitoring System to establish the practice expense component of Medicare’s reimbursement.  In 2007 the AMA developed the Physician Practice Information Survey (PPIS) to replace the outdated cost survey format.  The PPIS was completed in 2010 and implemented in 2011.  This new cost survey increases the practice expense and malpractice RVU which would increase Medicare reimbursement for 2011 if the conversion factor was not reduced.

Although President Obama signed H.R. 4994 (the Medicare and Medicaid Extenders Act of 2010) on December 15, 2010 which avoided the 25% reimbursement decrease, CMS needed to adjust the conversion factor so that their fee schedule remained budget neutral. 

To research the potential reimbursement impact, Alta Partners reviewed three providers in different specialties to calculate the reimbursement changes between 2010 and 2011.  We identified that the three providers are estimated to receive a reimbursement increase between 2.3% and 3.5% for their Medicare services.  This reimbursement increase is dependent upon the service mix and may vary when compared to other practices.

If you would like assistance identifying potential shifts in your reimbursement for 2011, please contact Jeff Kovacs at 440-808-3649 for additional information.

New Multiple Procedure Payment Reductions

The 2011 Physician Fee Schedule includes new multiple procedure payment reductions for 2011.

1. Imaging Services - have historically had a 25% reduction for the 2^nd or more imaging service within a session.  Starting in 2011, CMS has increased this multiple procedure reduction to 50%.  This reduction will apply to CT, CTA, MRI, MRA and ultrasounds.  This multiple procedure reduction is regardless of imaging modality and not limited to a contiguous body area and time.  CMS will recognize modifier 59 as a separate encounter needed within a 24 hour period of time.  CMS is also making the assumption that this separate visit is needed and medically necessary for the patient. 

In order to help billing for multiple imaging services, CMS has implemented three new CPT codes that can be used.

• 74176 (CT abdomen and pelvis, w/contrast material)
• 74177 (CT abdomen and pelvis, w/o contrast material)
• 74178 (CT abdomen & pelvis, w/o contrast in one or both body regions)

2. Therapy Services - new for 2011, CMS will be implementing a 25% reduction in the practice expense for “always therapy services”.  CMS has stated that this adjustment will account for the increased efficiency when performing 2 or more services.  The reduction applies to “same date of service for the same patient by the same practitioner or facility under the same NPI”. (CMS-1503-FC, p232)  These new multiple procedure reductions will apply to: Occupational Therapists, Physical Therapists and Speech Language Pathology.  Listed below is a list of the always therapy identified by CMS:

New Medicare Filing Limits

Effective immediately, CMS has implemented a new filing limit policy.  The new filing limit has been reduced from 15 months to 12 months from the date of service.  Alta Partners has already updated our internal policy and will make sure our clients’ claims are submitted timely to avoid denials.