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CMS Previews 2012 MPFS Final Rule

The Centers for Medicare & Medicaid Services (CMS) has released the 2012 Medicare Physician Fee Schedule (MPFS) rates final rule. The payment rate adjustment is effective for services delivered on or after January 1, 2012. As you will note, the announced rate reflects a 27.4 percent SGR downward adjustment. This downward adjustment is slightly less than the 29.5 percent reduction previously projected by CMS. Unless Congress intervenes to prevent this cut from taking place, physicians will experience a dramatic reduction in their Medicare fee schedule payments.

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2012 HCPCS II Available With Over 430 Changes

The Centers for Medicare & Medicaid Services (CMS) released Oct. 31 the Healthcare Common Procedure Coding System (HCPCS) Level II codes going into effect Jan. 1, 2012. Changes include 285 code additions (and one new modifier), 48 revisions, and 75 deletions. Another 18 codes were added and eight deleted throughout 2011.

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CMS Issues ACO Final Rule

The Centers for Medicare & Medicaid Services (CMS) issued a final rule Oct. 20 that encourages primary care doctors, specialists, hospitals, and other health care providers to coordinate their care for Medicare beneficiaries through accountable care organizations (ACOs). The Medicare Shared Savings final rule, created by the Affordable Care Act, provides more options for providers who wish to achieve this goal of high quality care that is more cost effective.

"This model of delivering care may not be right for everyone, but it provides new incentives for doctors, hospitals, and other health care providers to work together in new ways," said U.S. Department of Health & Human Services (HHS) Secretary Kathleen Sebelius.

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Advanced Primary Care Practice Demo Underway

For the next three years, 500 federally qualified health centers (FQHCs) in 44 states will participate in the Advanced Primary Care Practice demonstration. From Nov. 1, 2011 to Oct. 31, 2014, these health centers will be paid based on the quality of care they deliver. The U.S. Department of Health & Human Services (HHS) said in an Oct. 24 statement that it expects to dole out approximately $42 million for the demonstration, courtesy of the Affordable Care Act.

In exchange for funding, FQHCs must also expand their hours, make same-day appointments, and accommodate patients with urgent care needs.

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Meaningful EHR Users Rake in Millions

To encourage conversion to a standardized electronic health record (EHR) system, the Centers for Medicare & Medicaid Services (CMS) has paid $872 million through September to providers and facilities who have registered under a federal program, an official told an advisory committee recently.

The Medicare and Medicaid EHR Incentives programs offer incentives to providers and facilities to implement meaningful EHR use standards by 2014. The program was outlined as part of the American Recovery and Reinvestment Act of 2009.

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Medicare Covers Additional Preventive Services
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UHC Medicare Changes Brand Names
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CMS Takes Steps to Reduce Regulatory Burden
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