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CMS POLICY CHANGES FOR PHYSICIANS SERVICES TO MEDICARE PTS IN 2010

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  • Melinda
    Details for: CMS ANNOUNCES PAYMENT, POLICY CHANGES FOR PHYSICIANS SERVICES TO MEDICARE BENEFICIARIES IN 2010 For Immediate Release: Friday, October 30,
    Message 1 of 1 , Oct 30, 2009
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      Details for: CMS ANNOUNCES PAYMENT, POLICY CHANGES FOR PHYSICIANS
      SERVICES TO MEDICARE BENEFICIARIES IN 2010 For Immediate Release:
      Friday, October 30, 2009 Contact: CMS Office of Public Affairs
      202-690-6145

      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
      <http://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
      <http://www.cms.hhs.gov/apps/media/fact_sheets.asp>

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