iCMS released its CY 2012 Medicare Physician Fee Schedule (PFS) Final Rule, effective January 1, 2012. Notable provisions of the Final Rule include:
- A 27.4% reduction in payment rates based on the sustainable growth rate formula unless the cuts are again averted through legislation.
- An expansion of the potentially misvalued code initiative. CMS will focus on the codes billed by physicians in each specialty that result in the highest Medicare expenditures under the PFS.
- A change in how CMS adjusts payments for geographic variation in the cost of practice, including (i) the use of American Community Survey data instead of Department of Housing and Urban Development rental data and (ii) an adjustment in payments for the full range of occupations employed in physicians’ offices.
- An expansion of the multiple procedure payment reduction policy to the professional interpretation of advance imaging services.
- A set of criteria for health risk assessments (HRAs) to be used in conjunction with annual wellness visits (AWV) and an increase in AWV payments to reflect the increased office staff time necessary to administer HRAs.
- An expansion of services that can be furnished through telehealth for services beginning in CY 2013 including smoking cessation.
- Updates to various physician incentive programs, including the Physician Quality Reporting System, the ePrescribing Incentive Program, and the Electronic Health Records Incentive Program.
- The finalization of quality and cost measures for the value-based modifier that CMS will use to adjust physician payments for certain physicians starting January 1, 2015 and all physicians starting January 1, 2017.
