Health Information Management

Healthcare News: CMS releases 2010 Medicare physician fee schedule final rule

JustCoding News: Inpatient, November 11, 2009

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On October 30, CMS released a display copy of the Medicare physician fee schedule (MPFS) final rule for calendar year (CY) 2010. The MPFS sets payment rates for more than 7,000 types of services provided in physician offices, hospitals, and other settings.

The final rule reduces the conversion factor for services on or after January 1, 2010 by 21.2% instead of the 21.5% projected in the proposed rule, according to the CMS press release. This difference is due to the use of the most recently available data on CMS spending for physicians’ services.

“CMS is finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians’ services’ for purposes of computing the physician fee schedule update,” said Jonathan Blum, director of the CMS Center for Medicare Management, in the press release. “While this decision will not affect payments for services during CY 2010, CMS projects it will have a positive effect on future payment updates.”

CMS is also finalizing its proposal to stop paying for consultation codes other than the G codes used to bill for telehealth consultations. CMS plans to redistribute the resulting savings to increase payments for the existing evaluation and management services, according to the press release. CMS will also adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during that time.

In addition, CMS is increasing payment for the Initial Preventive Physical Exam, also called the “Welcome to Medicare” visit, to be more in line with payment rates for services of higher complexity.

To learn more about e-prescribing and physician quality reporting initiative provisions included in the final rule, access CMS’ fact sheet.

In other news, CMS also released a display copy of the 2010 outpatient prospective payment system (OPPS) final rule on October 30. For more information, view HCPro’s e-blast about this important news.

Editor's note: Interested in learning more about the OPPS final rule? Jugna Shah, MPH, Valerie A. Rinkle, MPA, and Kimberly Anderwood Hoy, JD, CPC, will discuss the changes to supervision requirements and the new formula for reimbursing separately payable drugs during the December 9 HCPro audio conference, “2010 OPPS Final Rule: Analyze the Impact and Manage the Changes.” To learn more or to purchase, go to the HCMarketplace Web site.

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