CMS has issued a proposed rule on a variety of Medicare payment policies for physicians and other practitioners. The changes, based on provisions in the healthcare reform law, the Patient Protection and Affordable Care Act of 2010, would apply to 2011 payments. There is a 60-day public comment period before the final rule is released in November.
Here are some highlights.
Higher automatic fee cut in 2011. Since the healthcare reform law did not alter the sustainable growth rate, the automatic fee cut would rise in 2011 by 6 percent, on top of the 21.5 percent fee cut at the end of 2010.
Shorter deadline for submitting Medicare claims. The deadline for submission of Medicare claims would be reduced from 15-27 months to one calendar year after the date of service.
Changes in relative value units. The proposal would change two components of relative value units, which help determine physician fees. Practice expense and malpractice RVUs would be adjusted slightly higher. To avoid a concomitant downward adjustment in work RVUs, due to the need for budget neutrality, CMS proposes a small decrease to the conversion factor.
Stark law changes for imaging. Physician practices furnishing PET, CT or MRI under the in-office ancillary services exception to the physician self-referral (Stark) law would have to provide a notice to patients referred for such services of their ability to obtain those services elsewhere. The notice would include a list of other sources of the services.
Payment for bone density tests. Payment for two dual-energy x-ray absorptiometry (DXA) CPT codes for measuring bone density would be revised to use 70 percent of their CY 2006 RVUs plus the 2006 conversion factor with the current year geographic adjustment.
Durable Medical Equipment Bidding Program. Round 2 of the Medicare durable medical equipment, prosthetics, orthotics and supplies Competitive competitive bidding program would be expanded from 70 metropolitan statistical areas (MSAs) to 91 MSAs.
Lower equipment utilization rate for imaging. The equipment utilization rate for CT, MR and PET would be reduced from 90 percent to 75 percent.
Incentive payments for primary care practitioners. Primary and other practitioners in primary care would receive an incentive payment equaling 10 percent of the normal Medicare payment for a new office visit, established patient office, other outpatient visits, and nursing facility and home health visits. Payments would be made quarterly.
Incentive payments for surgeons in shortage areas. Qualifying surgeons in Healthcare Professional Shortage Areas would receive an incentive payment equaling 10 percent of the normal Medicare payment.
Read the CMS fact sheet on the proposed changes.
Read the full proposal in the Federal Register.
Here are some highlights.
Higher automatic fee cut in 2011. Since the healthcare reform law did not alter the sustainable growth rate, the automatic fee cut would rise in 2011 by 6 percent, on top of the 21.5 percent fee cut at the end of 2010.
Shorter deadline for submitting Medicare claims. The deadline for submission of Medicare claims would be reduced from 15-27 months to one calendar year after the date of service.
Changes in relative value units. The proposal would change two components of relative value units, which help determine physician fees. Practice expense and malpractice RVUs would be adjusted slightly higher. To avoid a concomitant downward adjustment in work RVUs, due to the need for budget neutrality, CMS proposes a small decrease to the conversion factor.
Stark law changes for imaging. Physician practices furnishing PET, CT or MRI under the in-office ancillary services exception to the physician self-referral (Stark) law would have to provide a notice to patients referred for such services of their ability to obtain those services elsewhere. The notice would include a list of other sources of the services.
Payment for bone density tests. Payment for two dual-energy x-ray absorptiometry (DXA) CPT codes for measuring bone density would be revised to use 70 percent of their CY 2006 RVUs plus the 2006 conversion factor with the current year geographic adjustment.
Durable Medical Equipment Bidding Program. Round 2 of the Medicare durable medical equipment, prosthetics, orthotics and supplies Competitive competitive bidding program would be expanded from 70 metropolitan statistical areas (MSAs) to 91 MSAs.
Lower equipment utilization rate for imaging. The equipment utilization rate for CT, MR and PET would be reduced from 90 percent to 75 percent.
Incentive payments for primary care practitioners. Primary and other practitioners in primary care would receive an incentive payment equaling 10 percent of the normal Medicare payment for a new office visit, established patient office, other outpatient visits, and nursing facility and home health visits. Payments would be made quarterly.
Incentive payments for surgeons in shortage areas. Qualifying surgeons in Healthcare Professional Shortage Areas would receive an incentive payment equaling 10 percent of the normal Medicare payment.
Read the CMS fact sheet on the proposed changes.
Read the full proposal in the Federal Register.