ALS MEMBER UPDATE - November 8, 2001:
2002 PHYSICIAN FEE SCHEDULE

 

On November 1, 2001, the Physician Fee Schedule was updated for Calendar Year 2002. The Physician Fee Schedule is updated annually. Effective January 1, 2002, physicians who provide lithotripsy to a Medicare patient will be reimbursed a $542.26 professional fee, which is subject to geographic adjustments based on labor cost differences. The table below depicts the difference in facility, e.g., non-office setting, reimbursement rates between Calendar Year 2001 and 2002.

 2001 FACILITY RATE
 2002 FACILITY RATE
 DIFFERENCE
 $615.95
 $542.26
 -$73.69

Generally, the reimbursement rate is the product of three Relative Value Units ("RVUs"), namely work RVUs, malpractice RVUs and practice expenses RVUs. In 2002, the aggregate RVUs for the provision of lithotripsy in a facility setting, e.g., hospital outpatient setting, significantly decreased. In addition, the Physician Fee Schedule also employs a conversion factor to calculate the reimbursement rates. For 2002, the conversion factor is 5.4% less than the 2001 conversion factor.

Accordingly, the confluence of both the conversion factor reduction and the diminution in the aggregate facility RVUs caused the 11.9% decrease in the facility reimbursement rate for the provision of lithotripsy.

Ironically, the aggregate RVUs for the non-facility setting, e.g., physician's office, marginally increased (the 2002 reimbursement rate for the non-facility still results in a net decrease from the 2001 non-facility rate). This increase may be indicative of the Centers for Medicare and Medicaid Services' desire to shift the site of service for the provision of lithotripsy from the facility to the non-facility setting. The table below demonstrates the difference in the non-facility reimbursement for the Calendar Years 2001 and 2002.

 2001 NON-FACILITY RATE
 2002 NON-FACILITY RATE
 DIFFERENCE
 $765.16
 $738.82
 -$26.34

If you have any additional questions, please contact the American Lithotripsy Association at 781-895-9098.

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Visit us again to receive up-to-the-minute reports on major issues such as the Health Care Finance Administration's (HCFA) proposed implementation of the Stark II (Physician Ownership) regulations and HCFA's proposed rates for lithotripsy performed in/out patient and ambulatory surgical center settings.

For additional information contact, Wesley E. Harrington, CAE, Executive Director of ALS at:
American Lithotripsy Society, 305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Telephone: (781) 895-9098
Fax: (781) 895-9088

E-mail: als@lithotripsy.org


American Lithotripsy Society
305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Telephone: (781) 895-9098
Fax: (781) 895-9088
email:
als@lithotripsy.org


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