Medicare Releases Proposed Rule for 2009 Physician Payments
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July 3, 2008
On June 30, 2008 the Centers for Medicare & Medicaid Services (CMS) posted a proposed notice for Medicare payments in the physician fee schedule for calendar year (CY) 2009. CMS will publish this information in the July 7, 2008 Federal Register, with a comment period open until August 29, 2008.
The proposed rule includes detailed provisions addressing payment issues, relative value units (RVUs), anti-markup and self-referral issues, quality reporting initiatives, and value-based purchasing proposals. The proposed rule affects physicians, office and Independent Diagnostic Testing Facility (IDTF) payments for services paid under the resource based relative value scale (RBRVs), also known as the Medicare Physician Fee Schedule (MPFS).
Important proposed policies related to Nuclear Cardiology include:
- Unless legislation addressing the physician payment update is passed by Congress and signed into law by the President, the conversion factor for the remainder of 2008 (July to December) will be $34.0682 — 10.6% less than the conversion factor in effect for the first 6 months of 2008.
- 2009 marks the third year of a four-year transition to the revised practice expense (PE) methodology. Therefore, practice expense RVUs will be calculated as a weighted average of 75% of the values determined under the new formula and 25% of the values that would have been determined under the old formula. For 2009, CMS is not proposing any changes to the equipment usage percentage assumption of 50% or the equipment interest rate assumption (maintaining it at 11%) in the PE methodology.
- Consistent with the requirements of the Deficit Reduction Act (DRA), the proposed rule caps payment rates for imaging services under the MPFS at the amount paid for the same service when performed in the hospital outpatient setting.
- The proposed rule continues CMS’s policy of reducing the technical payments to diagnostic imaging procedures performed on contiguous body parts during the same patient care session by 25%. CMS will apply multiple imaging reductions first, followed by the OPPS imaging cap, if applicable.
- CMS proposes to require any physician or non-physician practitioner (NPP) entity that provides diagnostic imaging services to enroll in Medicare as an Independent Diagnostic Testing Facility (IDTF) and meet most of the Medicare quality and performance standards for IDTFs.
- The proposed rule contains two options for revising the anti-markup provisions adopted in the 2008 MPFS final rule. (Implementation was delayed until 2009 for most services.) The first alternative would not require application of the anti-markup rule to diagnostic testing services provided by a physician who shares a practice with a single physician or physician organization. In all other cases, the anti-markup rule would apply. The second alternative would clarify anti-markup provisions that were finalized in the MPFS CY 2008 final rule by providing guidance pertaining to various terms of the rule, including what would constitute the “office of the billing physician or other supplier” and other concepts such as “outside supplier.”
- The proposed rule includes CMS proposals for Physician Quality Reporting Initiative (PQRI) in 2009, as well as a solicitation for public comment on appropriate uses of the PQRI data, including public reporting.
The 2009 MFPS proposed rule is now posted on the CMS Web site at: http://www.cms.hhs.gov/physicianfeesched/downloads/CMS-1403-P.pdf.
The information from this proposed notice would be effective for services on or after January 1, 2009.
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