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CMS
ANNOUNCES PAYMENT, POLICY CHANGES FOR PHYSICIANS’ SERVICES TO MEDICARE
BENEFICIARIES IN 2010
The Centers for Medicare & Medicaid Services (CMS) today announced
final changes to policies and payment rates for services to be furnished
during calendar year (CY 2010) by over 1 million physicians and
nonphysician practitioners who are paid under the Medicare Physician Fee
Schedule (MPFS). The MPFS sets payment rates for more than 7,000
types of services in physician offices, hospitals, and other settings.
Today’s action complies with federal law, which requires these policies
and payment rates to be announced by Nov. 1.
Current law requires CMS to adjust the MPFS payment rates annually based
on an update formula which requires application of the Sustainable Growth
Rate (SGR) that was adopted in the Balanced Budget Act of 1997. This
formula has yielded negative updates every year beginning in CY 2002,
although CMS was able to take administrative steps to avert a reduction in
CY 2003, and Congress has taken a series of legislative actions to prevent
reductions in CYs 2004-2009. In the absence of Congressional action
for the CY 2010 physician update, the final rule with comment period will
reduce the conversion factor for services on or after Jan. 1, 2010 by 21.2
percent rather than the -21.5 percent projected in the proposed rule.
The difference is due to the use of the most recently available data on
CMS spending for physicians’ services.
“The Administration
tried to avert the pending fee schedule cut in the FY 2010 budget proposal
that it submitted to Congress, and remains committed to repealing the SGR,”
said Jonathan Blum, director of the CMS Center for Medicare Management.
“In the meantime, CMS is finalizing its proposal to remove
physician-administered drugs from the definition of ‘physicians’
services’ for purposes of computing the physician fee schedule update.
While this decision will not affect payments for services during CY 2010,
CMS projects it will have a positive effect on future payment updates.”
In the final rule with comment period, CMS is also adopting several
refinements to Medicare payments to physicians which will improve payment
rates for primary care services relative to other services. For
2010, for purposes of establishing the practice expense (PE) relative
value units (RVUs), CMS had proposed to include data about physicians’
practice costs from a new survey, the Physician Practice Information
Survey (PPIS), designed and conducted by the American Medical Association.
CMS is finalizing the proposal, but will phase it in over a four year
period. In addition, CMS will not use the PPIS data to determine the
practice expenses for medical oncology, but instead will continue to
use specialty supplemental survey data , as indicated by the Medicare
Prescription Drug, Improvement and Modernization Act of 2003 (MMA).
CMS is also finalizing its
proposal to stop making payment for consultation codes other than the G
codes that are used to bill for telehealth consultations, and to
redistribute the resulting savings to increase payments for the existing
evaluation and management (E/M) services. CMS will adjust the
payment for the surgical global period to reflect the higher value of the
office visits furnished during the global period.
In the final rule with comment period, CMS is adopting two significant
modifications to its proposal to increase the equipment utilization
percentage that is assumed for purposes of setting PE RVUs. CMS will
increase the equipment utilization rate assumption used to determine the
practice expense for expensive equipment priced over one million dollars
from 50 to 90 percent but will phase in this change over a four year
period. CMS also will not apply this change to expensive therapeutic
equipment.
CMS is increasing payment
for the Initial Preventive Physical Exam (IPPE), also called the
“Welcome to Medicare” visit to be more in line with payment rates for
higher complexity services. Originally established in the MMA, the
IPPE benefit now pays for an initial assessment of key elements of a
beneficiary’s health within one year of the beneficiary’s enrollment
in Medicare Part B.
Taking all changes in the
final rule with comment period into account, CMS projects that payments to
general practitioners, family physicians, internists, and geriatric
specialists will increase by between 5 and 8 percent, prior to application
of the negative update required by the SGR.
The final rule with
comment period also implements a number of provisions in the Medicare
Improvements for Patients and Providers Act of 2008 (MIPPA) including:
·
Adding new Medicare benefit categories for cardiac and
pulmonary rehabilitation services and for chronic kidney disease (CKD)
education beginning Jan. 1, 2010. The final rule with comment period
outlines what these programs will entail, how they will be
paid under the MPFS and
the criteria for covering these services.
·
Increasing the Medicare share of payments for outpatient
mental health services to 55 percent from 50 percent, beginning a gradual
transition to bring payment parity for mental health and medical services
furnished to Medicare beneficiaries.
·
Implementing a requirement that suppliers of the technical
component of advanced imaging services be accredited beginning Jan. 1,
2012. The accreditation requirement will apply to mobile units,
physicians’ offices, and independent diagnostic testing facilities that
create the images, but will not apply to the physician who interprets
them. CMS will address suppliers’ accountability, business
integrity, physician and technician training, service quality, and
performance management through additional guidance.
The final rule with comment period contains a number of provisions to
promote improvement in quality of care and patient outcomes through
revisions to the Electronic Prescribing Incentive Program (e-Prescribing
Program) and the Physician Quality Reporting Initiative (PQRI).
Specifically, the final rule simplifies the reporting requirements for the
electronic prescribing measure, provides eligible professionals with more
reporting options, and establishes a new process for group practices to be
considered successful electronic prescribers. Eligible professionals
or group practices that meet the requirements of each program in CY 2010
will be eligible for incentive payments for each program equal to 2.0
percent of their total estimated allowed charges for the reporting
periods.
In addition, CMS is adding
measures for eligible professionals to report under the PQRI, providing a
mechanism for participants to submit quality measure data from a qualified
electronic health record and creating a process for group practices to use
for reporting the quality measures.
The final rule with comment will appear in the Nov. 25, 2009 Federal
Register. CMS will accept comments on designated provisions of
the final rule with comment period until Dec. 29, 2009, and will respond
to all comments at a later date. Unless otherwise specified, the new
payment rates and policies will apply to services furnished to Medicare
beneficiaries on or after Jan. 1, 2010.
To view a copy of the final rule with comment
period, please see:
www.federalregister.gov/inspection.aspx#special
A fact sheet providing more information about the
e-Prescribing Program and PQRI provisions can be found at:
www.cms.hhs.gov/apps/media/fact_sheets.asp
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