CMS Issues Physician Fee Schedule Proposed Rule

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The Centers for Medicare and Medicaid Services has issued the 2012 Physician Fee Schedule proposed rule, which includes updated payment policies for physicians and nonphysician practitioners, according to a CMS news release.

CMS estimates total payments under the Medicare Physician Fee Schedule for calendar year 2012 will be $80 billion. Furthermore, in updating the Physician Fee Schedule, CMS is required by law to comply with the Sustainable Growth Rate formula, which is estimated to reduce Medicare payments to physicians by 29.5 percent. In previous physician fee schedules, however, payment cuts through the SGR have been canceled through legislation.

Some provisions of the proposed rule are required by past legislation. For instance, CY 2012 is the third year in a four-year transition plan for new practice expense relative value units, and therefore must calculate PE RVUs on a 75/25 mix of the new PE RVUs using data from the Physician Practice Expense Information Survey and previous PE RVUs based on data from the Socioeconomic Monitoring Surveys and other survey data.

In addition, CMS plans to recoup $10 million in CY 2012 by reducing payments for chiropractic CPT codes by approximately 2 percent as part of the budget neutrality requirement of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

The Physician Fee Schedule also includes an expansion of the potentially misvalued code initiative, a provision of the Affordable Care Act that aims to ensure accurate Medicare payments for physician services. The highest volume and dollar codes billed by physicians will be under scrutiny for overvaluation, and evaluation and management codes for undervaluation.

In addition to required changes, CMS is accepting comments for its proposed updates to the Physician Fee Schedule for 2012.

Some of the proposals include the following:

- Consolidate the Five-Year Review of Work and PE with the annual review of potentially misvalued codes so that reviews would occur at least once every five years through an annual process instead of once every five years.

- Add CPT codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes) to the list of telehealth services for CY 2012 on a category one basis. Add HCPCS codes G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) and G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes) to the list of telehealth services.

- Revise §415.130(d) so that for services delivered after Dec. 31, 2011, an independent laboratory may not bill Medicare for the technical component of physician pathology services to a hospital inpatient or outpatient.

- Require self-nominations for group practices that choose the eRx Incentive Program group practice reporting option.

- Modify 42 CFR 414.90(f)(1) to specify a 12-month reporting period — Jan. 1-Dec. 31 — for Physician Quality Reporting System quality measures for claims, registry and EHR-based reporting and for the group practice reporting option.

CMS will accept comments on the proposed rule until Aug. 30, 2011 and will issue a final rule by Nov. 1, 2011.

Read the CMS news release on the Physician Fee Schedule proposed rule.

Read CMS' Physician Fee Schedule proposed rule.

Related Articles on Physician Fee Schedules:
CMS Proposes Rescinding Signature Policy on Lab Requisitions

Physicians' Medicare Payments May be Cut 29.4%

FTC and Texas Align to Challenge Physician Network for Price Fixing

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