December 17, 2009 |
Issue No. 1 | |
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| Holiday Closings |
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IPC Billing will close for Christmas at 12:30 pm on December 24th and reopen the 28th. We will also be closed on January 1st for the New Year holiday.
Happy Holidays! |
| Reason for the Season |
This year IPC came together to sponsor three children in foster care for Christmas. We pooled over $600 to get them clothes and toys they would otherwise go without! |
Newsletter Archive
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Want to read a back issue of IPC's newsletter?
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Greetings!
Instead of holiday festivities, Medicare is giving providers a lump of coal in the form of a possible 21.5% reduction in fees and elimination of consultation codes. |
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Medicare Eliminates Consult Codes for 2010
As of this writing, Medicare will eliminate consult codes effective January 1, 2010. This affects office, hospital and nursing home consults and applies to Medicare Advantage Plans such as Medicare Plus Blue as well as original Medicare. It also applies whether Medicare/MA is primary or SECONDARY. However, other payers may continue to pay for consults and that creates great uncertainty - and possibly financial jeopardy - for you if you bill incorrectly. Here's the dilemma you face.
If Medicare or Medicare Advantage is primary, you must bill visit codes 99201-99205 or 99212-99215 for office services or 99221-99223 for hospital services. However, if a commercial carrier is primary and Medicare is SECONDARY, you may still bill a consult but there could be a huge financial consequence if you do so without knowing how the primary payer will adjudicate your claim. Here are two scenarios:
- Commercial payer reimburses the consult without a co-pay or deductible. This is great for you because you'll receive 100% of the commercial payer fee schedule.
- Commercial payer applies a co-pay or deductible or may determine the service is not a benefit (i.e. BCBSM may not pay for office visits). If you bill the primary payer and it applies some, most or all of your charge to deductible, co-pay or non-covered service, you CANNOT bill Medicare/MA as the secondary payer. You will be stuck with whatever the primary carrier pays - and that could be nothing.
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| Medicare Eliminates Consult Codes for 2010 |
 Alternatively, you could play it safe and bill only the visit codes regardless of whether Medicare/MA is primary or secondary. For inpatient visits, your reimbursement might stay about the same depending on the visit level you bill. But your office-based services are going to take a financial hit no matter what. Codes 99201-99204 and 99212-99215 pay a lot less than consults 99241-99245. See fee comparison below using 2009 fees.
There's another complicating factor on inpatient billing. CMS has mandated that the "Principal Physician of Record" must bill their initial service with the new AI modifier. Therefore, you must tell IPC Billing whether you are the attending physician or whether you are providing more limited services during the admission.
We're hoping CMS bows to pressure from providers and delays implementation but that may not happen. So you have only two weeks to figure out how you will make the transition from consult codes to visit codes.
The University of Florida has an excellent Power Point presentation for the new CMS coding guidelines. We highly recommend you view it:
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| Consults vs. Visit Codes |
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Here's a comparison of Consult vs. Visit codes using Medicare's 2009 fee schedule. Please note that Medicare intends to increase its fees for visits by approximately 6% to compensate for the deletion of consultation codes.
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Inpatient |
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Inpatient |
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Consult |
Fee |
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Visit |
Fee |
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| 99251 |
$48 |
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| 99221 |
$88 |
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| 99252 |
$75 |
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| 99222 |
$121 |
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| 99253 |
$113 |
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| 99223 |
$178 |
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| 99254 |
$163 |
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| 99255 |
$198 |
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Office |
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Office |
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Consult |
Fee |
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New Visit |
Fee |
Established Visit* |
Fee |
| 99241 |
$47 |
| 99201 |
$35 |
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| 99242 |
$88 |
| 99202 |
$61 |
99212 |
$36 |
| 99243 |
$121 |
| 99203 |
$89 |
99213 |
$59 |
| 99244 |
$179 |
| 99204 |
$138 |
99214 |
$89 |
| 99245 |
$220 |
| 99205 |
$174 |
99215 |
$121 |
*You must use Established Patient visit codes if the patient has been seen by you or anyone in your practice in the last three years.
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| About Us |
If you have any questions regarding this newsletter, you can contact us at:
Mary Ellen Duffy med@ipcbilling.com Patricia Nevala pat@ipcbilling.comor call us at 616-459-6867 or 800-606-1455
Please feel free to forward this newsletter to your staff and peers.
Innovative Practice Concepts, LLC -- A full service medical billing company
Your Bottom Line is our Top Priority!
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