CMS announces final rule for 2012 MPFS

The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a final rule with comment period to update payment policies and rates for physicians and nonphysician practitioners (NPPs) for services paid under the Medicare Physician Fee Schedule (MPFS) during 2012. The final rule reflects current law and reflects a 27.4 percent cut in reimbursement for services in 2012 under the Medicare Sustainable Growth Rate (SGR) formula. This is less than the previous estimate of 29.5 percent cut due to lower-than-expected growth in Medicare costs. The Obama administration has stated it is committed to ensuring these payment cuts do not take effect.

As part of its misvalued code initiative—an effort to ensure Medicare is paying accurately for physician services—CMS has targeted specific codes for review, including several high volume orthopaedic procedures such as spinal fusion, spinal laminectomy, total knee arthroplasty, and total hip arthroplasty. CMS is also making changes in the multiple procedure reduction rate for advanced diagnostic imaging tests and in how it adjusts payment for geographic variation in the cost of practice.

The final rule will appear in the Nov. 28, 2011, Federal Register. CMS will accept comments on provisions that are subject to comment until Dec. 31, 2011.

http://www.cms.gov/PhysicianFeeSched/PFSFRN/list.asp

Read the CMS press release…

http://www.cms.gov/apps/media/press/release.asp?Counter=415

CMS has issued additional fact sheets regarding the final rule.

Read "Final Changes for Calendar Year 2012 Physician Incentive Programs..."

http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4153

Read "Value-Based Payment Modifier and the Physician Feedback Program…"

http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4154

Read "CMS Announces Policy, Payment Rate Changes for the Physician Fee Schedule in 2012…"

http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4155