decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 11 (November)
Expect your 2007 Medicare pay to drop 12%
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Article Overview
This article summarizes the 2007 Medicare physician fee schedule final rule and explains the main drivers behind expected reimbursement changes. It is aimed at physicians, interventional specialists, and coding/billing professionals who need a high-level view of how CMS policy updates may affect Medicare Part B payment in the coming year. The piece covers conversion factor changes, budget neutrality adjustments, evaluation and management service revaluation, and imaging-related payment caps, along with a table comparing selected E/M payments for 2006 and 2007.
Why This Topic Matters
Medicare payment updates can affect practice revenue, service mix, and budgeting decisions, especially for specialties with a heavy procedural or imaging component. Understanding the broad categories of change helps practices anticipate financial impact and review their billing mix.
Article Sections
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Medicare physician fee schedule final rule
Introduces the CMS final rule and frames the expected year-over-year payment changes for physician services. Summarizes the broad payment impact across specialties.
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Conversion factor
Discusses the Medicare Part B conversion factor and its role in the overall payment update. Notes the year-to-year comparison and the possibility of congressional action.
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Budget neutrality adjustor
Explains the budget neutrality adjustment applied to work relative value units and its effect on the 2007 fee schedule. Describes how this adjustment interacts with other payment changes.
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E/M services
Reviews the evaluation and management service updates included in the final rule. Covers the general direction of payment changes and their relevance to office-based practice patterns.
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Imaging caps
Summarizes the policy affecting payment for diagnostic imaging performed in the office. Covers the broader framework for technical-component limits and related implementation changes.
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Refresher: Stage One of this “multiple imaging reduction”
Provides background on prior imaging payment reductions and the staged approach referenced in the article. Places the 2007 rule in the context of earlier policy changes.
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Check out how E/M national payments compare 2007 vs. 2006
Presents a payment comparison table for selected evaluation and management services. The table shows national payment changes between 2006 and 2007.
What You Will Learn
- The major CMS payment factors affecting the 2007 Medicare physician fee schedule
- How the article frames reimbursement impact across specialties
- The broad categories of policy changes discussed in the final rule
- Why evaluation and management and imaging policies are central to the analysis
- What the included payment comparison table is intended to show
Who Should Read This
- Physicians
- Interventional specialists
- Cardiologists
- Vascular surgeons
- Radiation oncologists
- Anesthesiologists
- Medical coders
- Billing professionals
- Practice managers
Codes Discussed
Code Ranges Discussed
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