Medicare Payment Rule Includes AAFP-Sought Improvements
The Centers for Medicare & Medicaid Services (CMS) issued the 2011 final physician fee schedule on November 2, 2010. Included in it are several improvements as recommended by AAFP in a regulatory comment letter submitted on July 28, 2010.
Of particular interest to family physicians are policies that:
- Significantly improve the eligibly rules for the Primary Care Incentive Program (PCIP) so that “over 80 percent of physicians who currently are enrolled in Medicare with a primary specialty designation of family medicine … would qualify for the PCIP based on CY 2009 claims data,” according to the agency. Compared with CMS’ initial proposals, the final policy will allow considerably more family physicians to successfully qualify for the 10-percent bonus for primary care services as called for in the Affordable Care Act (ACA). Based on suggestions from AAFP and other primary care physician groups, CMS will now exclude all non-physician fee schedule allowed charges (i.e., charges associated with labs, imaging, and durable medical equipment supplies) and hospital E&M codes when determining PCIP eligibility.
- Greatly expedite when newly enrolled Medicare primary care physicians become eligible for the PCIP.
- Reaffirm the agency’s 2010 decision to eliminate consultation codes (which allowed better payment for E & M codes).
- Clarify definitions, patient eligibility requirements, and payment levels for the new ACA-authorized Annual Wellness Visit and the Initial Preventive Physical Examination.
- Finalize CMS’ definition of preventive services.
- Reduce significantly the 2011 e-prescribing reporting burden, as AAFP had recommended: rather than requiring practices to report on 50 percent of all applicable services, CMS will award the entire year’s bonus after a practice reports e-prescribing just 25 times.
- Expand to 12 months (from the agency’s initial proposal of 6 months) the time physicians have to file a Part B claim under an exception to the ACA requirement that all Medicare claims must be submitted within 12 months.
- Expand the list of approved Medicare telehealth services, as AAFP had suggested.
Until it expires at the end of November 2010, the Medicare conversion factor is $36.8729. CMS also included in the final rule information pertaining to the approaching reductions in Medicare physician payments. Unless Congress intervenes, the final 2011 conversion factor as published in the final regulation will be $25.5217 on January 1, 2011.