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.

Evaluation and Management – CEMC

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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10 Responses to “CMS Releases Part B Proposed Rule”

  1. F. Patrick Novak MD says:

    Shouldn’t also be an Increase for Anesthesiologist, who employ Electronic Record Keeping technology,
    during Anesthesia Provision?

  2. Lynn Berry says:

    Everyone needs to write to respond to this rule regarding your areas of interest. However, the part regarding eliminating the consult codes, allowing physicians to charge initial hospital visits (even if they are not the admitting physician) and initital outpatient visits at a higher rate will eliminate all the confusion regarding consults and help physicians overall. Only catch is that admitting physicians will need to add a modifier to their initial visit code to denote their status. Also recognizing the work that goes into the Initial Preventative Exam for Medicare will alert more physicians to utilize this code and give better service to the patients.
    Changes in the PE component of the RVU affect different specialties differently, so be sure and not them.
    Read the PQRI updates as well, as there are a lot of changes. If you don’t participate, we all lose.

  3. Danielle Casey, CPC Anesthesia Office Manager says:

    I agree that Anesthesia should be included with an Anesthesia Provision for Hospital or ASC based charges!

  4. Trish Morin-Spatz, CPC says:

    Making changes to payments for Medicare is crazy! There are no incentives for doctors to see Medicare patients anymore and it is the patients that lose. Uncle Sam should stop continuing to confuse the average coders with changes in our world and focus on where the real waste is…their own world where government employees are paid to sit around on the job and the taxpayers lose! For years, they have sat by idly and let the military dependents who also have private insurance receiev the same charges as the military employees. Billions of dollars have been lost like this with the private insurance companies gaining the profits. It will take some real strength in our world to get the folks at Medicare to realize that Medicare needs to simply state what they will pay for services up front and let the chips fall where they may. I for one, am angry!

  5. karyn cardenas says:

    what a mess!! they are always cutting from the wrong places.. I do not understand why we still have to pay Medicare tax then, there is never going to be enough. The place they need to cut from is government salaries, starting with the governor of California..these people get paid top dollar to come up with solutions, since there are no solutions then maybe they need to take a cut in pay and redistribute that money into the Medicare system… I agree it’s the patients and the physicians that lose the most, then the insurance compancies pretty much dictate the care.. SCARY!

  6. Nancy Farrington says:

    I like the concept of eliminating the consult codes. It would do away with alot of confusion on the physicians part. I agree with Lynn Berry, that a modifier would have to be created to alert the admitting physician. I agree that the insurance companies seem to dictate how a physician treats a patient. Their CEO’s make millions in profit along with the drug companies. I could go on and on.

  7. Juddi Schneider, CPC, CPC-I, CCS-P says:

    I believe eliminating the consults is an excellent idea. While it is another change, I think in the long run this will simplify E&M Coding. Who has not spent time explaining and re-explaining the difference between consults and transfer of care? As I understand it there will be an increase in the reimbursement for E&M codes to make up for the elimination of consults.

  8. Donna Young, CPC says:

    I was just doing that very thing this morning…explaining consults again! It would be nice to have an easier solution as long as the pay was there. E/M is an interesting world!

  9. Tami F, CPC says:

    I am for eliminating the consult codes. There is such confusion and explaining gets frustrating.

  10. Margie Miles, RMA, CPC, PCA says:

    I am for eliminating the consult codes. There is such confusion and explaining gets frustrating.

    But cut payment by 21.5 percent is insane. Doctor’s will not be able to see Medicare patients or maybe none. CMS is hurting the Medicare patient.

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