2007 RVU Snag

The 2007 RVU changes were a bit of a mess. Read the AAP’s RVU brochure you’ll see this little tidbit:

Budget Neutrality: Statutory guidelines indicate that revisions to the RVUs for physician services may not alter physician expenditures within the Medicare RBRVS physician fee schedule by more than $20 million from the principal expenditures that would have resulted if the RVU adjustments were never initiated. CMS normally maintains Medicare budget neutrality exclusively via annual adjustments to the Medicare Conversion Factor. However, in 2007 the Medicare program will additionally apply a separate budget neutrality adjustment factor to the physician work RVUs to ensure Medicare budget neutrality in light of work RVU increases tied to the 2005 Five-Year Review.

In 2007, Medicare decided to stay within its budgetary requirements by adding an “after market” adjustment of about 5% to all of the codes. It’s a trick, frankly. They kept the CF at $37.90, yet cut the work factor by ~10%. The problem is that private insurance companies are using this pay cut as well, even though they have no such similar budgetary requirements.

I’ve been trying to assemble some good fightin’ language to help our clients who are running into this. I don’t have much there, unfortunately. At the very least, however, if the 2007 RVUs are being used for your practice, make sure you’re getting paid for the 99173, 92551, 99339, and 99340…2007 is their first year with values! (Those would be vision, hearing, and home health codes for those scoring at home.)

Boy, I’ve got to get the new RVU tool out. All CPTs, all the time!