The 411 for 2010

By Lyn Walsh

Ms. Walsh supports customers in South Carolina, North Carolina, southwest Virginia, northeast Tennessee, and east Georgia.

“Hope for the best, plan for the worst, and prepare to be surprised!” Unknown

There is no doubt that 2009 was an interesting and challenging year for everyone, especially in health care. Changes in reimbursement for clinical services, programs from the federal government regarding new technology, and other possible legislation (local and national) have dominated conversations with our physicians. Now that 2010 is here, where do these issues stand and how will they affect our physicians?

MEDICARE REIMBURSEMENT

Medicare, the federal government’s health care plan for Americans aged 65 and older, is a very important payer for ophthalmologists, covering about 42 million beneficiaries. In an average practice, Medicare can represent 40% to 60% of revenue. Medicare fee schedules are also used as a standard of reimbursement for other payers, and any changes in Medicare can have a large ripple effect. It’s easy to see why Medicare reimbursement rates are always a hot topic for physicians. Medicare reimbursement amounts are determined in part by a conversion factor. This number is multiplied by the value for each CPT code (called the relative value unit, or RVU). Because of legislation passed in July 2008 that reduced the conversion rate, physicians were facing a possible reduction of 21% in reimbursement. On December 20, 2009, Congress passed a bill that freezes the conversion rate at the 2009 rate until February 28, 2010. This is only a temporary fix, and we hope a fair and more long-term solution is in place before the February deadline.

ELECTRONIC PRESCRIBING (eRX)

For 2010, the Center for Medicare & Medicaid Services (CMS) simplified the requirements for the eRX bonus payment. This year, physicians need to report only when they create a prescription using their eRX system. To do this, they attach a specific code (G8553) to the appropriate claim. If physicians report at least 25 times during the calendar year, they have met the requirement for the bonus. In 2010, physicians can earn a bonus of 2% of their total 2010 Medicare Part B charges.

PHYSICIANS QUALITY REPORTING INDEX (PQRI)

PQRI was created in 2006 to reward physicians who successfully reported on specific quality measures for covered medical services provided to Medicare beneficiaries. In 2010, physicians can choose to report for the entire calendar year of 2010, or choose to report only for July – December 2010. Physicians who meet the requirements for PQRI measures are eligible for a bonus of up to 2% of their total Medicare Part B charges for their reporting period.

ELECTRONIC MEDICAL RECORDS (EMR)

EMR continues to be a hot topic, as the first year for bonus for successful use of a qualified EMR system begins in 2011. The challenge is that CMS has not yet defined what “successful use” and “qualified system” mean. Our advice for physicians considering adopting an EMR system is to make their decisions for the right reasons: Is the practice ready? Is the system right for the practice? Making the EMR choice based solely on a possible bonus could be disastrous and expensive. We encourage physicians to do their homework and take their time to make the right decision.

Challenges and Opportunities

Undoubtedly, 2010 will bring many more challenges and opportunities for everyone in eye care. Contact your Eye Care Business Advisor to learn more about the many Allergan Access® tools and resources that are designed to help you assist your practices in areas related to the “business” of eye care.