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Member-only
analysis of 2010 final fee schedule available
The
Centers for Medicare & Medicaid Services (CMS) published the final
Medicare physician fee schedule for 2010 in the Federal Register on
Nov. 25. The fee schedule contains payment rates for covered services,
changes to Medicare policy, and a number of other changes that will
significantly affect medical practices. The rule:
- Eliminates
the use of all consultation codes (inpatient and office/outpatient
codes for various places of service except telehealth consultation
G-codes) on a budget-neutral basis by increasing the work relative
value units (RVUs) for new and established office visits, increasing
the work RVUs for initial hospital and initial nursing facility
visits, and incorporating the increased use of these visits into
practice expense (PE) and malpractice RVU calculations.
- Finalizes a
proposal to remove physician-administered drugs from the definition of
“physician services” for purposes of computing the physician update
formula. This long-awaited administrative step mitigates the size of
future Medicare Part B reductions.
- Phases in
new PE RVUs over four years using revised survey data that will result
in significant increases and decreases to the PE values of many codes.
- Establishes
a Physician Quality Reporting Initiative (PQRI) reporting mechanism
via qualified electronic health records.
- Defines the
size of a group practice as at least 200 providers for the new PQRI
group-practice reporting option.
- Increases
the utilization assumption for diagnostic equipment priced at more
than $1 million, which will decrease the technical component payment
for services performed on this equipment. This change will be phased
in over four years.
Access
the exclusive, member-only
MGMA analysis of the final fee schedule.
MGMA
seeks immediate clarification from CMS on Medicare Advantage fraud and
abuse education deadline
The Medical
Group Management Association (MGMA), the American Medical Association (AMA)
and 85 organizations sent a letter to
CMS in support of the agency’s proposal
to rescind requirements regarding fraud and abuse education for Medicare
Advantage (MA) providers. The letter reiterates MGMA's objections to the
Dec. 31 training deadline and strongly urges CMS to immediately clarify
that physicians who have enrolled in the Medicare program need not comply
with the deadline, which is being imposed by many MA plans. Additionally,
the letter outlines ongoing concerns regarding abusive MA plan audits of
physician practices.
CMS
releases resources for PQRI feedback reports, as well as links to 2010 PQRI
measure specifications
The Centers for Medicare & Medicaid Services (CMS) recently posted several
resources to help Physician Quality Reporting Initiative (PQRI)
participants review feedback reports, as well as prepare practices that are
considering participation in the 2010 PQRI.
2007 re-run and 2008 PQRI feedback report resources
Practices can use a “verify
report portal” to confirm whether a feedback report exists based on a
Tax Identification Number (TIN) or a National Provider Identifier (NPI). If
a report exists, there are two ways to access it.
Individual eligible professionals may call their local
Medicare contractor and request that the contractor e-mail the report
based on the individual NPI. Individual physicians in a group practice
setting may individually use this option. For further information on this
process, access CMS MLN educational article SE0922.
Group practices that want to access feedback reports at the TIN level must
once again use the PQRI
Portal on the QualityNet Web site, which also requires a user ID and
password to the Individuals Authorized Access to CMS Computer Services
(IACS) system. Use the CMS
IACS account management page to verify access to your IACS account.
Further
IACS resources are available by calling the External Users Services (EUS)
Help Desk at 866.484.8049 (Monday – Friday, 7,a.m.-7 p.m., EST) or via
e-mail at EUSSupport@cgi.com. CMS
also posted the PQRI
and eRx Quick-Reference Support Guide for Eligible Professionals, which
contains helpful resources for practices trying to access their PQRI
report(s). Finally, practices that need additional assistance may call the
QualityNet Help Desk at 866.288.8912 (Monday-Friday, 7 a.m.-7:00 p.m., CST)
or via email qnetsupport@sdps.org.
2010
PQRI coding documents
CMS
also recently posted documents for practices planning to participate in the
2010 PQRI. The 2010
PQRI Measures Specifications Manual for Claims and Registry Reporting
of Individual Measures and Release Notes contains the authoritative
documents describing the 2010 measure specifications and coding changes
from the 2009 PQRI measure specifications. The 2010
PQRI Implementation Guide and the 2010
PQRI Measures List both contain information needed for successful
participation. The 2010
PQRI QDC Categories is a table that outlines each quality data code
(QDC) that must be reported for each measure.
These
links and other essential 2010 PQRI information regarding the 2010 PQRI
measures groups and the 2010 PQRI EHR measure specifications are available
on the CMS
PQRI measures codes Web site.
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Dec. 9, 2009
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