chirotalk@chirocode.com January 05, 2003 ChiroTalk An Email update by ChiroCode Institute and DH Leavitt January 4, 2003 Good news and Bad news: Federal Register - RVUs and FEES down 5% 2003 Medicare Fee Schedule - $2 dollars less for 98940 Security - HIPAA and Identity theft Printing press starts to roll - but Federal Register - RVU and FEES down 5% The good news: The annual Medicare Physician Payment Fee Schedule was finally published in the Federal Register on December 31st, Tuesday of this week. Yep, they got it done before the year was over. Barely! It is two months late. For the last two fun-filled days I have reviewed this annual publication. If you are not familiar with it, it contains all of the final decisions for the coming year about coverage, coding and fees by CMS/Medicare. The introduction is 127 pages long with rationale on all issues for the year. The last 129 pages contains the updates on the Relative Value Units (RVUs), dollar conversion factors, and fees for 2003. It is down about 5% for 2003. It is a lot of fine print, and information overload. However, here is my distillation for Chiropractic clients and friends! Much in the preamble was their rationale for reduced RVUs and fees for the year; as they shifted blame back on congress for the formulas they have to work with. (e.g Sustainable growth rate for all healthcare expenses, etc.) Because the total dollars spent exceeded the amount specified by law, it had to be brought into compliance. The biggest overrun was attributed to anesthiology; but the result is that every specialty/discipline suffers in the aggregate consideration in a lower dollar conversion factor. 2003 Medicare Fee Schedule - $2 dollars less for 98940 This is what happened to National RVUs for the basic Chiropractic codes: Code 2002 RVU 2003 RVU Difference 98940 .71 .70 down .01 98941 .98 .97 down .01 98942 1.27 1.27 same 98943 .75 .65 down .10 But the biggest difference is in the Dollar Conversion Factor (DCF), which is the multiplier to the RVU to equal a fee. Here is that report: 2002 2003 Difference $36.20 $34.59 Down $1.61 The bad news: About $2.00 less for every 98940 service performed across America for 2003. (Assumption of $40 as the Allowed amount X a 5% reduction; or $l.50 less for Allowed amounts at $30 ) Your Medicare Administrator/carrier will send you the specific data soon. Interestingly, the average reduction for all categories of providers was 5%, which happened to be same as the 5% for chiropractic. With the delays, the updated implementation of the new 2003 Fees is set for March 1st at the local Administrator/carrier level. That gives two extra months at the old higher 2002 rates. Therefore, from a business perspective, be prompt in submitting claims for Jan and Feb 2003. If enough doctors (including DCs) in America storm the Bastille (Congress), the problem could be fixed in a few months. Perhaps claims for any services during March and April could be held for little while, pending a changed payment formula at the congressional level. Hopefully, Dr Frist the new majority whip will make it a high priority. It is more than just Medicare? Absolutely, even if you see NO Medicare patients this still affects you! That is because a majority of all payers use the Medicare Fee schedule as a base, and then add on a percentage for their payments. Also, more and more state governments (Workers Comp, etc) also use the Medicare Fee schedule as a base for their reimbursement rates. This 10% cut to physician payments in the last 2 years is an egregious burn-down rate. Angry yet? Congress has a lot of issues, but this is too hot of an issue to not fix immediately. They made the problem. Only they can fix it. Let's get it on their front burner. Call your elected representatives to Washington DC today. If there is no action, it will be even worse next year. Additionally, there are more updates, policies and useful information in the Fed Reg than this bad news. Those updates and more will be in your 2003 ChiroCode DeskBook and coming Hot Topics newsletters. For example: new place of service codes for mobile units, urgent care, and homeless shelters; ALSO updated polices for physical therapists and occupational therapists; for incident to services; for nutritional therapy; for electrical stimulation of wounds; for self referral prohibitions; etc. Security - HIPAA and Identity theft On December 14th, it happened right here in Phoenix, our backyard! Burglars stole confidential computers files from TriWest, making off with computer hard drives containing sensitive data to about 500,000 military personnel, retirees and family members around the world. There is a $100,000 reward posted for information on the burglars. Assuredly, the Accountability portion of the Health Insurance Portability and Accountability Act of 1996, is certainly needed for all of us. This break-in and burglary underscores the need of SECURITY standards for protected health information (PHI) in every healthcare office. The final HIPAA rules for Security are about to be posted. We have pondered ..what type of security standards did this TriWest have? If they had excellent security standards, were they ignored? Identity theft is now becoming a more serious threat to us all. If you are a HIPAA entity, go with the flow and not begrudge the increased Security burdens, any more than the hassles at our airports. Even if you are not a HIPAA entity, lets give your patients all the privacy and security assurances that their protected health information (PHI) deserves. Printing press start to roll - but they are not as fast as email Now that the RVUs are here, we have entered them and FEES into the 2003 ChiroCode DeskBook this week. The commercial presses starts next week, but the first 6,000 books (and the CD that comes with it) will take a few weeks. Production is NOT as fast as email. We are hoping for shipment at the end of January. Thanks for your patience. It will have the CURRENT RVUs and FEES! It is also the best edition ever. Happy New Year D H Leavitt, President leavitt@chirocode.com