On July 30, 2012 CMS will publish a major proposed rule addressing changes to the physician fee schedule, payments for Part B drugs, and other Medicare Part B payment policies to ensure that the payment systems are updated to reflect changes in medical practice and the relative value of services. The proposed rule would also implement provisions of the Affordable Care Act by establishing a faceto-face encounter as a condition of payment for certain durable medical equipment (DME) items. In addition, it would implement statutory changes regarding the termination of non-random prepayment review under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Finally, this proposed rule also includes a discussion regarding the Chiropractic Services Demonstration program.
The proposed rule also addresses new claims-based data reporting requirements for therapy services to implement a provision in the Middle Class Tax Relief and Jobs Creation Act (MCTRCA). In addition, this rule proposes:
● Potentially Misvalued Codes to be Evaluated.
● Additional Multiple Procedure Payment Reductions (MPPR).
● Expanding Medicare Telehealth Services.
● Regulatory Changes regarding Payment for Technical Component of Certain Physician Pathology Services to Conform to Statute.
● Primary Care and Care Coordination Service.
● Payment rates for Newly Covered Preventive Services.
● Definition of Anesthesia and Related Care in the Certified Registered Nurse Anesthetists Benefit.
● Ordering Requirements for Portable X-ray Services.
● Updates to the Ambulance Fee Schedule.
● Part B Drug Payment Rates.
● Ambulance Coverage-Physician Certification Statement.
●Updating the–
- Physician Compare Website.
- Physician Quality Reporting System.
- Electronic Prescribing (eRx) Incentive Program.
- Medicare Shared Savings Program.
● Providing Budget Neutrality Discussion on the Chiropractic Demonstration.
● Physician Value-Based Payment Modifier and the Physician Feedback Reporting Program.
● Medicare Coverage of Hepatitis B Vaccine.
● Updating Existing Standards for e-prescribing under Medicare Part D and Lifting the LTC Exemption.
Several proposed changes would affect the specialty distribution of Medicare expenditures. This proposed rule reflects the priority on improving payment for primary care services. Overall, payments for primary care specialties would increase and payments to select other specialties would decrease due to several changes in how CMS proposes to calculate payments for CY 2013.