Showing posts with label fee schedule for Medicare. Show all posts
Showing posts with label fee schedule for Medicare. Show all posts

Monday, August 29, 2011

Medicare Fee Schedule 2012: Train Eyes on Potential Imaging Fee Cuts

CMS released its proposed MPFS for the coming year on July 1 this year.

The Centers for Medicare & Medicaid Services (CMS) payment proposals for the coming year indicate the situation could get all the more challenging. Here's a proposed fee schedule update you need to be aware of.

Train eyes on potential imaging fee cuts

A couple of months back, CMS released its proposed Medicare Physician Fee Schedule ( Source "http://www.supercoder.com/coding-tools/fee-schedules")(MPFS) for the coming year. The 621-page document provides you insight on how the agency configures its relative value unit (RVU) assignments.

If the proposed rule becomes final, imaging pay will see more cuts. Presently, when you carry out multiple radiological procedures on the Multiple Procedure Payment Reduction (MPPR) list during a single session, Medicare brings down the technical component (TC) of the lower paid procedure(s) by half. However, the agency wants to bring down those payments further.

In the coming year, the agency is laying down that it will not only cut the TC of subsequent radiological procedures by 50 percent, but will also slash the PC by half. Total payment would be made for the PC and TC of the highest procedure, and payment would be brought down by 50 percent for the PC and TC for each additional procedure provided to the same patient in the same session. It also points to the fact that payment cuts to radiology procedures could be even more in two years from now, and beyond that.

Professional societies were critical of the agency's radiology cuts. The American Medical Association (AMA) vehemently opposes a proposal to use major cuts to Medicare payments for diagnostic imaging to pay off the cost of a trade agreement. Diagnostic imaging specifically has already seen significant reductions over the last five years. In fact, payments for some services have gone down over 60 percent and more cuts are likely to take place.

What's more, a lot of radiologists have laid down that multiple interpretations of exams carried out on one patient are not less work-intensive than multiple interpretations of different patients. The time, intensity and mental effort it takes to interpret an individual exam is relatively constant irrespective of whether the patients' exams are interpreted separately or at the same session. Medicare should make an effort to support such quality care and not try to weaken it repeatedly.

Tuesday, August 9, 2011

Medicare fee schedule: CMS to expand the potentially misvalued code initiative

According to CMS, the total payments under the Medicare Physician Fee Schedule (MPFS) in CY 2012 will be $80 billion.

In an effort to ensure Medicare is paying appropriately for physician services and more closely managing the payment system, the agency is expanding the potentially misvalued code initiative, a July 1 CMS press release notes.

In 2011, the agency is focusing on the highest volume and dollar codes billed by physicians to find out whether these codes are overvalued and if E/M codes are undervalued. Prior to this, the agency targeted specific codes for review that may have impacted a few procedural specialties like cardiology, radiology or nuclear medicine however not taken a look at the highest expenditure codes across all specialties, the agency cites.

Strong efforts are required to assess fee schedule for Medicare ( Source "http://www.supercoder.com/coding-tools/fee-schedules") to see to it that it is paying right and ensuring that Medicare beneficiaries remain to have access to vital services, the release stresses. That aside, the agency is also proposing some changes in how it adjusts payment for geographic variation in the cost of practice.

Other changes in the proposed rule include:

The agency is also proposing to expand its multiple procedure payment reduction to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services, the agency release cites.

The agency is also proposing criteria for a health risk assessment to be used with AWVs for which coverage began on January 1 this year under the affordable care act.

The agency will accept comments on the proposed rule until August 30 this year.

For more on this fee schedule update, click here