CMS Releases 2011 Physician Fee Schedule Proposed Rule
CMS released its proposed rule for policy changes to the 2011 physician fee schedule effective Jan. 1, 2011, and its implementation of key provisions under recently enacted health reform legislation, the Affordable Care Act.
Download the fact sheets released by CMS:
- CMS to Expand Medicare Preventive Services and Improve Access to Primary Care In 2011
- Affordable Care Act Provisions and the CY 2011 Medicare Physician Fee Schedule Proposed Rule
- Changes to the Physician Quality Reporting Initiative and the Electronic Prescribing Incentive Program
The proposed rule will be published in the Federal Register on July 13. CMS will accept public comments on the rule until Aug. 24. AGA will also submit comments for CMS's consideration prior to release of the final rule by Nov. 1, 2010.
Also, after months of fighting against Medicare physician payment cuts, AGA is glad to announce that the President has signed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act into law. It provides a 2.2 percent update in payment rates, retroactive from June 1 through Nov. 30, 2010.
CMS has instructed its carriers to process claims at the 2.2 percent rate and will reprocess any claims at the negative 21.3 percent rate as soon as possible to reflect the new rate. CMS has indicated that providers do not need to resubmit claims that were already submitted to their contractors. AGA will continue to provide any new information on this issue from CMS. Learn more by reading the AGA Washington Insider, a policy blog for GIs.
Components of Proposed Rule
The proposed rule projects a -6.1 percent reduction to physician payment rates in 2011 under the sustainable growth rate (SGR) formula, absent additional Congressional intervention. CMS estimates the 2011 conversion factor will be set at approximately $26.6574.
Effective Jan. 1, 2011, the Affordable Care Act waives the Part B deductible for tests that begin as colorectal cancer screening tests but, based on findings during the test, become diagnostic or therapeutic services. AGA advocated heavily for this change. We are also pleased that the Affordable Care Act extends the preventive focus of Medicare coverage to provide coverage for annual wellness visits during which beneficiaries receive personalized prevention plan services. AGA views this as an opportunity to counsel beneficiaries on colorectal cancer screenings.
The Physician Quality Reporting Program (PQRI) will provide a 1 percent payment incentive for 2011, 0.5 percent incentive payment from 2012 through 2104, and penalties for non-participation in PQRI of 1.5 percent in 2015 and 2 percent in 2015.
For the 2010 PQRI, the AGA Digestive Health Outcomes Registry ™ is qualified for reporting on the hepatitis C measures group for at least 30 patients, two of whom must be Medicare Part B fee-for-service patients. The proposed 2011 rule requires that when this reporting methodology is used, all 30 patients must be Medicare Part B fee-for-service patients.
The gastroenterology individual measures and hepatitis C measures group remain in the proposed 2011 PQRI measures.
The rule adds key changes the E-Prescribing Incentive Program for 2011, specifically, EPs who participate and qualify for the Medicare Electronic Health Records Incentive Program for 2011 may not receive a separate, additional Medicare eRx Incentive Program payment. There will also be broader opportunities for group practices with fewer than 200 members to participate in the eRx Incentive Program as group practices.
CMS will also proceed with developing a "Physician Compare Web site," which CMS will populate with 2011 PQRI data that will include names of providers submitting 2011 PQRI data.
The Affordable Care Act requires physicians referring patients for MRI, CT and PET scans in which they may have a financial interest to disclose to a patient in writing at the time of the referral that there are other suppliers of these imaging services, along with a list of other suppliers in the area in which the patient resides.
Stay tuned to AGA eDigest and the AGA Washington Insider for a more comprehensive analysis of this proposed rule.
