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Medicare increase still contains glitches for ophthalmology
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WASHINGTON — The reversal of the scheduled Medicare reduction will result in a 1.6% increase beginning March 1, said the American Society of Cataract and Refractive Surgery (ASCRS). The new conversion factor released by the Centers for Medicare and Medicaid Services (CMS) was published in the Federal Register Feb. 28.
Though the reimbursement rates will take effect March 1, claims for services provided in January and February are still subject to the conversion factor 2002 rates, but the carrier can automatically adjust the paid claim in July and send refund requests. If claims for this time period are submitted after March 1, they will temporarily receive the 2003 rates until July, the ASCRS said.
The CMS is also extending the Medicare physician enrollment period through April 14. The new enrollment and fee schedule information will not be automatically sent but will be posted on its Web site.
The 2003 rates are based on recalculated relative value units (RVU) that continue to be revised. In 1997, Congress passed legislation for reimbursement rates to be calculated from resource-based practice expense RVUs. The revised rates were to be phased in over 4 years while the CMS continues to revise them.
According to the ASCRS, there are two changes in the CMS’s methodology that produced a 1% average reduction in the 2003 practice expense RVUs for ophthalmology services.
The final rule (proposed Dec. 31, 2002) further reduces Medicare payments. The rule includes a behavioral offset adjustment of –0.9951 to the practice expense relative value units to “account for an anticipated increase in the volume and intensity of services in response to payment reductions from refinement of practice expense RVUs.”
For more details on the regulation, click here.