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2000 Medicare Fee Schedule implements some positive changes
ASCRS released an analysis of the 2000 Medicare Fee Schedule as it relates to ophthalmologists.
The Health Care Financing Ad-ministration (HCFA) implemented many long overdue revisions to the year 2000 Medicare Fee Schedule, resulting in some positive changes for ophthalmology. Total projected payments to ophthalmology will increase 6% when the practice expense values are fully implemented in 2002 — 4% during the last refinement process and the additional 2% during this phase — resulting in a net increase of $210 million annually.
After a sneak peek at an advance copy of the final rule, the American Society of Cataract and Refractive Surgery (ASCRS) released an analysis of the rule as it relates to ophthalmologists, concurrent with the final rule’s publication in the Federal Register. Further refinements of the Practice Expense Relative Value Units (RVUs), positive changes to the “zero-work” pool, and implementation of Resource Based Malpractice RVUs will have the most impact on ophthalmologists, according to ASCRS.
The final rule incorporates refinements to the practice expense data forwarded to HCFA by the American Medical Association’s Relative Value Update Committee (RUC). “This refinement incorporates many overdue corrections aimed at more evenly distributing practice expense revenues among codes that were proposed by the ophthalmic community and had been submitted to HCFA on several occasions over the last 2 years,” ASCRS stated. “These corrections redistribute practice expense dollars from eye codes to surgical ophthalmic procedures. While HCFA made these changes, the agency also pointed out that all practice expense inputs are still subject to further refinement and potential review by the RUC.”
Ophthalmology out of the pool
In HCFA’s November 1998 final rule, ophthalmology was negatively impacted by the creation of a separate practice expense pool for all services with zero work RVUs. Objections from the ophthalmic community resulted in HCFA removing ophthalmology services from the zero work pool in the 2000 Medicare Fee Schedule and returning them to the practice expense pools for ophthalmology. This will result in an increase in total allowable charges of 3% for ophthalmology.
According to the American Academy of Ophthalmology (AAO), the big win in the fee schedule is increased payments for visual fields and other diagnostic tests, which will be paid at a higher rate, resulting in an additional $100 million.
AAO’s recommended correction of a practice expense error to the 92012 eye exam code was applied, improving payments for eye surgery. On the downside, the new malpractice RVUs will result in a 0.5% decrease in ophthalmology’s allowable charges. However, according to ASCRS, HCFA has indicated that all malpractice RVUs will be interim until they can be verified by more data.
Perseverance pays off
“We have been fighting hard for these changes and have had to overcome several roadblocks along the way, but our perseverance has paid off with this ultimate win,” said William L. Rich III, MD, AAO’s secretary for federal affairs. “It’s satisfying to see that our work has made such an impact on ophthalmology payments, but we are disappointed that all of our edits were not implemented. We expect to have these edits re-instituted in 2000, resulting in increased surgical fees.”
Although HCFA did not include AAO’s recommendation to include the costs of clinical staff in the facility setting when calculating practice expense payments for medical services, Dr. Rich said AAO did thwart off the deep payment cut to surgical services that was originally projected.
In the final rule, HCFA maintains its position on excluding the costs of clinical staff in the facility setting from the data used in calculating practice expense payments for medical services. HCFA concluded that it “remains convinced that our position in the proposed rule was correct. It is not typical for physicians to bring their own staff into the facility setting.” Practice expense RVUs for surgical services that include in their data the cost of bringing clinical staff to a hospital or an ambulatory surgery center will decrease as a result of this provision, according to ASCRS.
For Your Information:
- William L. Rich III, MD, can be reached at the American Academy of Ophthalmology, 1101 Vermont Ave. NW, Ste. 700, Washington, DC 20005-3570; (202) 737-6662; fax: (202) 737-7061; Web site: www.eyenet.org. Dr. Rich is the secretary for federal affairs at the American Academy of Ophthalmology.