May 22, 2012

CMS Releases 2012 Physician Fee Schedule Proposed Rule

CMS issued a proposed rule (CMS-1524-P) with updates to the payment policies and rates for the Medicare Physician Fee Schedule (MPFS).

In a press release, CMS highlighted the following changes in the proposed rule:

  • Expansion of the multiple procedure payment reduction to the professional component of advance imaging services; specifically, CT, MRI, and ultrasound.
  • Proposed criteria for a health risk assessment for use in conjunction with annual wellness visits.
  • Addition of smoking cessation services to the list of telehealth services.
  • Proposed quality and cost measures for establishing a new value-based modifier to reward physicians for higher quality and more efficient care.
  • Implementation of the third year of a four-year transition to new practice expense RVUs.
  • Continued efforts to identify potentially misvalued codes.

CMS noted its projected conversion factor of 29.5% for 2012 based on the application of the sustainable growth rate formula. CMS does not address this in the proposed rule because a reduction in the 2012 factor can only be addressed with a change in law.

CMS is accepting comments on the proposed rule until August 30, 2011.

©2012 von Briesen & Roper, s.c

About the Author

Meghan O’Connor is a member of the Health Care Practice Group. Her practice focuses on general health law including managed care and provider contracting, risk management, and regulatory compliance.

Prior to joining von Briesen, Meghan worked for the Centers for Medicare and Medicaid Services where she consulted with states regarding federal health law, regulation and policy, evaluating managed care contracts and conducting compliance reviews.

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