Washington Connexion, Nov. 2, 2011

CMS finalizes 2012 Medicare physician fee schedule

The Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Physician Fee Schedule for 2012. Unless Congress intervenes, the rule implements a 27.4 percent reduction in Medicare physician payments in 2012 based on the sustainable growth rate (SGR) formula. MGMA will continue its steadfast advocacy efforts to repeal the flawed SGR formula.

The final rule also:

• Significantly expands CMS's focus under the Misvalued Code Initiative on the highest volume and dollar codes billed by physicians to determine which codes are over- or undervalued
• Requires a Health Risk Assessment as a component of the Medicare Annual Wellness Visit, with a slight payment increase
• Repeals a requirement, which had not yet been enforced, that treating physicians sign paper requisition forms for clinical diagnostic laboratory tests 
• Redefines “group practice” under the Group Practice Reporting Option for the Physician Quality Reporting System as a group of 25 or more eligible professionals
• Establishes two e-prescribing incentive program reporting periods for 2013 and 2014 – 1) full year using claims, registry or EHR-based reporting methods to report the measures at least 25 times to receive the incentive payment; 2) Jan.1 - June 30 to report measures at least 10 times on claims to avoid the next year’s payment adjustment
• Allows four e-prescribing incentive program  hardship exemptions for 2013 and 2014
• Reimburses physicians at the reduced “facility rate” for services performed at entities wholly owned or operated by hospitals when those services are related to an inpatient admission that occurs within 3 days of receiving such services
• Expands the Multiple Procedure Payment Reduction to the professional component (PC) of certain imaging services by applying a 25 percent reduction (as opposed to the proposed 50 percent reduction) to the payment for the PC of second and subsequent CT, MRI and ultrasound services furnished by the same physician to the same patient in the same session on the same day

CMS released additional information on its Web site. MGMA will continue to analyze this final rule and will provide a detailed analysis as a member benefit. For the latest news regarding Medicare physician payment, visit mgma.com/policy.