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CMS Proposes Changes to Physician Fee Schedule

CMS Proposes Changes to Physician Fee Schedule

In the June 29th Federal Register, the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rule making that concerns changes to the Medicare Physician Fee Schedule for 2007, including a revision of physician work Relative Value Units (RVUs) that could mean an increase in emergency physician reimbursement for providing Evaluation and Management (E/M) services.

Although the values published in the proposed rule will not be final until the comment period ends and the final rule for the 2007 Medicare Fee Schedule is published in late fall, work RVUs for emergency department E/M codes should have significant increases. The actual financial impact for each member will depend on several factors such as patient volume, payer mix, service mix, and frequency distribution. The combination of these factors can have a significant impact on the total annual Medicare payment in the ED.

Visit to use a reimbursement calculator that will estimate the expected reimbursement increases for 2007 and beyond.

"The actual impact will depend on final assignment of total RVUs for each code and any changes to the Medicare conversion factor that may result from the Sustainable Growth Rate (SGR) factor and/or budget neutral adjustments," pointed out David McKenzie, ACEP's Reimbursement Director. "CMS is proposing to make the required budget neutrality adjustment by reducing the work RVUs for all CPT codes by 10 percent. If this methodology is implemented, there will be a negative impact on the proposed increase to our RVUs.

"It's still subject to change, but this proposed rule is a positive indication that CMS will improve the amount of payments to emergency physicians for the services they provide to Medicare beneficiaries," he added. "Also, over time, any increase in RVUs for ED codes could translate to rate increases from some other payers as well."

By law, CMS must review all the codes valued by the RBRVS Update Committee (RUC) every five years to ensure the codes are appropriately valued. ACEP is emergency medicine's only representative on this committee that makes recommendations to CMS.

To use the calculator or find out more about the proposed changes, visit

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