Though Congress passed legislation at the eleventh hour to temporarily avert the 27.4 percent cut in Medicare physician reimbursement, all other changes in the 2012 Medicare physician fee schedule went into effect Jan. 1, 2012.
The correction notice published in the Federal Register modifies the relative values for many services. The revised relative value file reflects both the corrections and the legislation that temporarily averted the 27.4 percent cut. Read more.
Highlights from the final fee schedule include:
- Misvalued code initiative—The Centers for Medicare and Medicaid Services (CMS) will look at the highest expenditure codes across all specialties to determine which codes are over- or under-valued.
- Physician Quality Reporting System (PQRS)—Finalizes 29 measures for reporting under the PQRS and defines a group practice as a group of 25 or more eligible professionals. For more information, read the fact sheet from CMS. Physicians will have the option to submit data through a qualified EHR system. However, they should be aware that the EHR certification process does not test for the product’s ability to output a file that would meet PQRS file specifications.
Meaningful use—Allows physicians to participate in the PQRS Medicare Electronic Health Record Incentive Pilot to satisfy the clinical quality measures reporting objective for the purpose of demonstrating meaningful use. For more information, read the fact sheet from CMS. - Value-based payment modifier— Finalizes quality and cost measures to be used to establish a new value-based modifier, which would adjust physician reimbursement based on the quality and efficiency of the care they provide. For more information, read the fact sheet from CMS.
- Observation care codes—Relative value units (RVUs) for subsequent observation services will mirror those of subsequent hospital inpatient services.
- ePrescribing incentive program—Establishes two full reporting periods and four ePrescribing hardship exemptions for 2013 and 2014
- Health Risk Assessment (HRA)— Requires an HRA as part of the Medicare Annual Wellness visit, with an increase in physician reimbursement
- Telehealth services—Expands the list of services that can be furnished through telehealth to include smoking cessation services. This change will affect services proposed for the telehealth list starting in 2013.
- Three-day payment window—Medical practices, wholly owned or operated by a hospital, will be required to resubmit charges for services provided to a patient who becomes an inpatient within a three-day period, by attaching a newly-created HCPCS modifier that will alert CMS to pay for the physician services at the lower facility rate.
If you are a PAMED member and have any questions about the 2012 Medicare fees, please contact our division of practice economics and payer relations at (800) 228-7823, ext. 2644.