decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 1 (January)
No cut in Medicare fee schedule…for now
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Article Overview
This article covers a short-term Medicare physician fee schedule change, the role of RVUs and conversion factors in fee calculation, and how private insurers may respond when setting their own reimbursement schedules. It is aimed at physicians, pediatric practices, medical coders, and billing staff who monitor fee schedule changes and payer behavior. The piece also discusses payer benchmarking for services without Medicare RVUs and the possible reimbursement implications of insurer conversion to for-profit status.
Why This Topic Matters
Changes in Medicare fee schedules can ripple through commercial payer contracts, affecting reimbursement expectations beyond Medicare itself. Understanding these broad fee schedule trends helps practices anticipate payer adjustments and monitor how benchmark pricing may be applied.
What You Will Learn
- How a Medicare physician fee schedule update can influence commercial payer reimbursement behavior
- How RVUs and conversion factors are used in fee schedule calculations at a high level
- Why some services may require alternative benchmarking when Medicare does not assign RVUs
- How payer mergers or conversion to for-profit status may affect fee schedule structure
Who Should Read This
- Physicians
- Pediatricians
- Medical coders
- Medical billing staff
- Practice managers
- Revenue cycle personnel
Modifiers Discussed
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