Pulmonology Coding Alert

Question: I heard that Medicare providers will face a 'catastrophically large' pay cut in 2012. What are the details regarding this development?

Utah Subscriber

Answer: Starting Jan. 1, CMS will employ a 27.4 percent reduction to physician pay. The Centers for Medicare and Medicaid Services published its 2012 Medicare physician fee schedule on Nov. 1 (see www.cms.gov/apps/media/press/release.asp? Counter=4156&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&sr for details). The fee schedule revises the payment rates for thousands of medical services and establishes other regulatory policy.

The CMS final rule states that "under current law, providers will face steep across-the-board reductions in payment rates, based on a formula -- the Sustainable Growth Rate (SGR) -- that was adopted in the Balanced Budget Act of 1997.

Without a change in the law from Congress, Medicare payment rates to providers paid under the MPFS will be reduced by 27.4 percent for services in CY 2012 -- less than the 29.5 percent reduction that CMS had estimated in March of this year because Medicare cost growth has been lower than expected."