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March 27, 2018

Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More

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OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More

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Medical Coding News Archives

Physician Payment Gets Temporary Boost in 2014

January 24, 2014:

Nannette Orme, CPC, CCS-P, CPMA, CEMC Clinical/Technical Editor

Physician Payment Gets Temporary Boost in 2014.

The Pathway for SGR Reform Act of 2013 signed into law on December 26, 2013, increases physician reimbursement by 0.5 percent from January 1 through March 31, 2014. The Centers for Medicare and Medicaid Services (CMS) has announced that the new 2014 conversion factor will be $35.8228. In addition, the Geographic Practice Cost Indexes (GPCI) for the physician work component will have a floor of 1.0 through March 31, 2014.

CMS has updated the Medicare physician fee schedule (MPFS) and reposted it to its website. Unlike in years past, the file has not been renamed, but the file name does include the word “updated.”

In past years, the changes to the initial conversion factor have resulted in changes of 0.01 and 0.02 to a majority of the relative value units (RVU). For the 2014 update, the RVUs were changed for only two codes, G0422 and G0423.

The MPFS is used to calculate certain outpatient prospective payment system (OPPS) services. The values for the facility and nonfacility practice expense and malpractice expense for OPPS only changed for a significant number of procedure codes to maintain the same reimbursement even with the change to the conversion factor.

The anesthesia, GPCI, and OPPS cap files were also changed. The change in conversion factor required a change to the anesthesia file that lists the conversion factor by locality. The GPCI file contains changes to the floor of the work component to a minimum of 1.0 for the affected states. The OPPS cap file was changed consistent with the changes to the MPFS RVU file.

The updates to the MPFS files are valid only through March 31, 2014. Optum will provide updates when available regarding additional legislative changes to the MPFS.


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