A display copy of the annual Medicare Physician Fee Schedule was released on October 30 by the Centers for Medicare and Medicaid Services (CMS). The final rule, which contains a plethora of regulatory changes, initiatives, and clarifications, will guide Medicare's payment and coverage policies for health care professionals, facilities, and Medicare beneficiaries beginning January 1, 2010.
In August of this year, AAPA submitted official comments to CMS on a number of provisions contained in the proposed fee schedule rule. The 2010 final rule represents decisions reached by CMS officials after consideration of comments offered by interested parties.
Here's a look at some of provisions in the final rule:
- Medicare is projecting a 21.2 percent decrease in the 2010 fee schedule. This payment decrease, based on a congressionally mandated payment formula known as the sustainable growth rate (SGR), is not a surprise. Health care professional groups such as AAPA have been lobbying Congress for months to have the decrease rescinded. For the past 8 years Congress has intervened to offset the proposed decrease. It is expected that Congress will play the same role this year to avoid payment reductions. Nearly everyone, including CMS officials, wants to prevent the decrease.
"The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR," said Jonathan Blum, director of the CMS Center for Medicare Management.
- CMS will permanently remove
the cost of
physician-administered drugs
from the definition of
physician services in the
SGR. This action will
mitigate future fee schedule
decreases, but excluding the
cost of
physician-administered drugs
won't affect the 2010
schedule.
- CMS officials made a
decision to eliminate
reimbursement for outpatient
and inpatient consultation
codes (except for G codes
that are used to bill
consults as part of the
telehealth benefit).
Reimbursement that had been
paid for consultations will
result in increased payments
for existing new and
established patient
evaluation and management or
E/M services in a budget
neutral manner. Payment
adjustments will be made to
the surgical global period
payment to reflect the
higher value of E/M office
services furnished during
the 10- or 90-day post-op
timeframe.
- A benefit category for cardiac and pulmonary rehabilitation services was established. However, CMS stated that the statutory language in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires that a physician provide immediate and direct supervision of cardiac, intensive cardiac, and pulmonary rehabilitation services.
AAPA argued, and CMS officials agreed, that in the 2010 Outpatient Prospective Payment System proposed rule, PAs have the ability to provide direct supervision of services they personally perform within State scope of practice and hospital privileging guidelines. In addition, statutorily PAs provide care to Medicare beneficiaries based on the overarching concept that PAs deliver "physician services," and the inability of PAs to supervise cardiac and pulmonary rehabilitation services will hinder beneficiary access to these vital services.
CMS responded that it is their belief that MIPPA language was specific to physician performance of the direct supervision responsibilities in these specific areas and that they did not have the authority to extend the supervision responsibilities to non-MDs/DOs. AAPA reimbursement staff will continue to pursue this issue with CMS officials.
- Language that defines a PA
as a "qualified person"
eligible to provide kidney
disease patient education
services to patients with
Stage IV chronic kidney
disease.
- An increase in the Medicare
payment percentage for
mental health services from
50 to 55 percent. Medicare
will adjust its payment
percentage each year until
it reaches the 80 percent
payment threshold - putting
coverage of mental health
services at the same rate as
other Medicare covered
services.
- The addition of 30 Physician
Quality Reporting Initiative
measures that health care
professionals utilize to
report quality care measures
and qualify for the 2
percent Medicare bonus
payment.
- A payment increase in the initial preventive physical exam or the so-called "Welcome to Medicare exam" that is provided for Medicare beneficiaries within the first 12 months of Medicare enrollment.
If you're suffering from a case of temporary insomnia and care to read through the more than 1,600-page fee schedule, it can be found at http://www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf
