CMS Proposes Policy

CMS Proposes Policy, Payment Rate Changes for the Physician Fee Schedule in 2012

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would update payment policies and rates for physicians and non-physician practitioners (NPPs) for services paid under the Medicare Physician Fee Schedule (MPFS) in calendar year (CY) 2012. Under current law, providers would face steep across-the-board reduction in payment rates, based on a formula – the Sustainable Growth Rate (SGR) – that was adopted in the Balanced Budget Act of 1997. If it goes into effect, Medicare payment rates are projected to be reduced by 29.5 percent for services in 2012. This is the eleventh time the SGR formula resulted in a payment cut, although the cuts have been averted through legislation in all but CY 2002. In 2010, three separate pieces of legislation were necessary to avert the payment cuts, followed by two additional enactments that authorized increases in the physician update, resulting in higher payment rates for physicians’ services performed between Jun 1, 2010 and Dec 31, 2011.

The proposed rule would update a number of physician incentive programs including the Physician Quality Reporting System, the e-Prescribing Incentive Program and the Electronic Health Records Incentive Program. Additionally, it includes proposed quality and cost measures that would be used in establishing a new value-based modifier that would reward physicians for providing higher quality and more efficient care. The Affordable Care Act requires CMS to begin making payment adjustments to certain physicians and physician groups on January 1, 2015, and to apply the modifier to all physicians by January 1, 2017. CMS will accept comments on the proposed rule until Tue August 30, 2011, and will review and respond to all comments in a final rule to be issued by Tue November 1, 2011. The AMCNO is reviewing the rule at this time.

To read the entire CMS Press release click here: http://www.cms.hhs.gov/apps/media/press_releases.asp

Also, for additional information please the CMS Fact Sheets (7/1) click here: http://www.cms.hhs.gov/apps/media/fact_sheets.asp

Physician Fee PPS Rule at Federal Register (PDF): http://www.ofr.gov/OFRUpload/OFRData/2011-16972_PI.pdf