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CMS proposes payment change rates for 2012 Physician Fee Schedule
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The Centers for Medicare & Medicaid Services has proposed a rule that would update payment policies and rates for physicians and non-physician practitioners for services paid under the 2012 Medicare Physician Fee Schedule, with a total payment projection of $80 billion.
The proposed 2012 rule expands what the Centers for Medicare & Medicaid Services (CMS) referred to in a press release as “the potentially misvalued code initiative.” The expansion is part of a CMS effort to better ensure accurate Medicare payments for physician services.
Under current law, Medicare providers face across-the-board reductions in payment rates based on the Sustainable Growth Rate (SGR) formula adopted in the Balanced Budget Act of 1997. The law would mean a projected 29.5% reduction in 2012 Medicare payment rates for services.
“This payment cut would have serious consequences, and we cannot and will not allow it to happen,” CMS Administrator Donald M. Berwick, MD, stated in the release. “We need a permanent SGR fix to solve this problem once and for all. That’s why the president’s budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix.”
According to the release, the CMS is focusing this year on the highest volume and dollar codes billed by physicians to determine whether the codes are overvalued — and if evaluation and management codes are undervalued.
Further proposals include changes in payment adjustment for geographic variation in the cost of practice. This process involves using American Community Service (ACS) data in place of Housing and Urban Development rental data, as well as using ACS data in place of the data currently used for non-physician employee compensation.
According to the release, further changes involve the expansion of multiple procedure payment reduction to professional interpretation of advance imaging services, the expansion of the list of services that can be furnished through telehealth, the update of a number of physician incentive programs and the implementation of the third year of a 4-year transition to new practice expense relative value units based on data from the Physician Practice Information Survey adopted in the 2010 Medicare Physician Fee Schedule.
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