Medicare Physician Fee Schedule 2012

Date: December 31, 2011

The Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3765) signed by President Obama on December 23, 2011, provides for a 60-day delay in the 27.4% cut in Medicare physician reimbursement scheduled to take effect on January 1, 2012. Despite the “delay”, your fee schedule will change. A slightly modified conversion factor of $34.0376 will be utilized to calculate physician reimbursements during January and February. Other changes published in the final ruling posted in November will be implemented January 1, 2012, including relative value unit (RVU) changes.

Many Medicare contractors have already published 2012 physician fee schedules with the planned reduction. In an effort to ensure proper reimbursement with the appropriate fee schedule, CMS instructed contractors to hold all 2012 claims for ten business days (until Jan. 17). Watch your Medicare website for the short-term fee schedule applicable to your locale.

The uncertainty of the fee schedule also extends the Participation Enrollment Program from November 14, 2011 to February 14, 2012. The deadline is typically December 31. Any changes made to your participation status would be effective January 1, 2012.

If this all sounds familiar, it should. We encountered the same type of delay and minor changes in January 2010. Let’s hope we don’t have a repeat of that year, with multiple short-term fixes!

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