We have been awaiting news for this year’s fee schedule revision with Medicare and have the following information to share. Please note: Medicare has requested a reduction in payments for the last 4 years and congress has always (so far) intervened; however, the rate reductions has never been above 10%.  If they remove the physician administered drugs, the RVU calculations used for determining time/supplies will increase value (up the fee schedule rate the reduction will come from).   We will keep you updated with any additional information as we receive it.

CMS Proposes 21.5% Cut in Medicare Doc Payments

Physicians would receive a 21.5% cut to their Medicare payments starting Jan. 1, 2010, under a proposed rule issued by the CMS. In a major step to revise the way it pays physicians, the agency is also proposing to remove physician-administered drugs from the formula used to calculate Medicare’s physician fee schedule. The proposal to take drugs out of the formula won’t prevent the anticipated cut in 2010; however, physicians will experience fewer years of negative updates if it is implemented.

The American Medical Association, which has been pushing for this measure for years, applauded the proposal. “The removal of physician-administered drugs from the broken Medicare physician payment formula is a major victory for America’s seniors and their physicians,” J. James Rohack, president of the AMA, said in a written statement. “The AMA has been calling for this action since 2002 so that Congress can afford to repeal the flawed Medicare physician payment formula.”

The sustainable growth rate formula ties Medicare physician payments to several factors, including changes in the economy. Physicians would experience the 21.5% cut in 2010 unless Congress intervenes, as it has in the past.

Contact: CMS Office of Public Affairs

202-690-6145

CMS PROPOSES PAYMENT, POLICY CHANGES FOR PHYSICIANS SERVICES TO MEDICARE BENEFICIARIES IN 2010

The Centers for Medicare & Medicaid Services (CMS) announced today proposed changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS).  The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings.

CMS is also proposing to stop making payment for consultation codes, which are typically billed by specialists and are paid at a higher rate than equivalent evaluation and management (E/M) services.   Practitioners will use existing E/M service codes when providing these services instead.  Resulting savings would be redistributed to increase payments for the existing E/M services.

CMS will accept comments on the proposed rule until August 31, and will respond to all comments in a final rule to be issued by November 1, 2009.  Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after January 1, 2010.

For more information on the proposed rule, please see:

www.federalregister.gov/inspection.aspx#special or

http://www.archives.gov/federal-register/public-inspection/index.html