CMS Releases Part B Proposed Rule
A proposed rule that addresses Part B payment policies paid under the Medicare Physician Fee Schedule (MPFS) went on display today in the Federal Register. The proposed rule with comment period includes several policy changes intended to help offset a much-anticipated payment cut in 2010.
Physicians and nonphysician practioners (NPPs) paid under the MPFS are facing a projected 21.5 percent payment cut unless new legislation is passed, as has happened before, to somehow offset it.
To that end, the Centers for Medicare & Medicaid Services (CMS) is proposing to make the following Part B policy changes with the intention of increasing payment rates for primary care services:
- Update the practice expense component of physician fees
- Remove physician administered drugs from the definition of “physician services”
- Stop making payment for consultation codes. Physicians would use evaluation and management (E/M) codes, and CMS would increase payment rates for these codes
- Increase the payment rate for the Initial Preventative Physical Exam (IPPE), or “Welcome to Medicare” visit
- Refine how Medicare recognizes the cost of professional liability insurance in its payment system
According to CMS, these changes alone will result in a projected 6-8 percent increase in payments (before the proposed update and other changes to the fee schedule).
Additionally, participating physicians who successfully report Electronic Prescribing Incentive and Physician Quality Reporting Initiative (PQRI) program measures would qualify for incentive payments in 2010 up to 2.0 percent of their total estimated allowed charges for each program. Provisions to further promote quality of care via these incentive programs and to simplify reporting requirements are also being proposed.
The proposed rule would also implement, effective Jan. 1, 2010, provisions in the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 that added new Medicare benefit categories for cardiac and pulmonary rehabilitative services and for chronic kidney disease education.
To further reign in costs, however, CMS is proposing to reduce payment for imaging services and implement a MIPPA requirement that suppliers of the technical component of advanced imaging services be accredited beginning Jan. 1, 2012. This requirement would apply to mobile units, physicians’ offices and independent diagnostic facilities that conduct imaging but would not apply to physicians who interpret the images.
CMS is accepting public comment on this proposed rule until Aug. 31. CMS will publish the final rule Nov. 1. Unless otherwise noted, new policies and payment rates will go into effect Jan. 1, 2010.
Look for further details on this proposed rule on AAPCNews and in Coding Edge magazine.
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