Medicare Compliance & Reimbursement

While lawmakers attempt to heal the problems with the 2008 fee schedule, the Centers for Medicare & Medicaid Services churns forward with proposed cuts that could hurt health providers in 2009.

Under the proposed 2009 Medicare Physician Fee Schedule (published in the July 7 Federal Register), physicians' pay would drop by 5.4 percent in January. If, however, President Bush signs H.R. 6331 into law, the 5.4 cut proposed for 2009 would be replaced by a 1.1 increase in pay.

Physician practices that don't want to gamble on H.R. 6331 are contacting CMS in droves to express their disappointment with the 2009 proposed fee schedule. CMS is accepting comments on the proposal until Aug. 29, and intends to issue a final rule by Nov. 1.

"I recommend that practices read the entire final rule before commenting to CMS," suggests Randall Karpf with East Billing. "There are proposals in there that affect almost every specialty."

Earlier this year, the AMA revealed on its Web site that 60 percent of physicians intended to limit the number of new Medicare patients that they would treat if the physician pay cut were to go into effect. CMS, however, sees things differently.

"CMS has been carefully monitoring beneficiary access to physicians' services," said CMS Acting Administrator Kerry Weems in a June 30 statement. "To date, our studies, as well as studies by the Medicare Payment Advisory Commission, reveal that beneficiaries in most areas of the country are having little or no trouble in seeing their physicians and we expect this to continue in 2009."

In addition to proposing physician pay rates, the 2009 fee schedule also details programs and incentives that CMS intends to move forward next year, including the following:

• Expand upon the PQRI program by introducing the final set of quality measures and increasing the number of conditions covered by measures groups.

• Require office-based physicians and non-physician practitioners who perform diagnostic testing to enroll as diagnostic testing suppliers and meet the quality and performance standards required of independent diagnostic testing facilities (IDTFs).

• Require physicians to retain the NPIs of ordering or referring providers for ten years from the date of service.

To read the entire proposed rule or to submit your comments on it, visit www.regulations.gov and type "CMS-1403-P" in the "comment or submission" field.