How Will the New Payment Rates for 2012 Affect Your Practice?

November 17, 2011

AGA has analyzed the Medicare physician fee schedule (MPFS) 2012 final rule to determine its impact on gastroenterology. The final rule reduces reimbursement rates for physician services in 2012 by 27.4 percent — a drastic cut that AGA is committed to fighting. AGA, along with all of organized medicine, will continue to advocate for a permanent solution to the broken payment system that provides fair, equitable and predictable reimbursement to physicians.

To help you better understand the impact of these cuts to your practice, AGA has prepared a payment analysis for GI codes paid under the physician fee schedule, which details payment rates with the 27.4 percent reduction. In addition, we have included an analysis of what payments would be if Congress mandates a short-term fix with a payment freeze.

AGA has also prepared an in-depth summary of the rule that highlights the aspects of most importance to GIs. The MPFS includes a new AGA IBD measures group under the 2012 Physician Quality Reporting System. The IBD measures group can only be submitted via registry. Additionally, the rule finalized quality and cost measures that will be used to establish a new value-based modifier to adjust physician payments based on quality of care.

Also of importance is CMS’ final proposal to send a list of high expenditure/high volume, potentially misvalued codes to the AMA Relative Value Scale Update Committee for review, which includes codes 45378 diagnostic colonoscopy and 43235 upper GI endoscopy, diagnosis. CMS noted the list of codes were selected for review based on the fact that they have not been reviewed for at least six years and, in many cases, the last review occurred more than 10 years ago.

The rule will appear in the Federal Register on Nov. 28, 2011. CMS will accept comments on those provisions that are subject to comment until Jan. 3, 2012, and will respond in the MPFS for calendar year 2013.