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February 9, 2012

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Fallout from Fall 2011:  What was that all about?

With all of the year-end political wrangling and regulatory changes, exactly where does everything stand now?  This month's PBN Minute takes a detailed look at what changed late last year (most of which took effect in January) and what it means for you in the future.

SGR Physician Payment Cut Date Delayed

Friday, December 23, 2011, President Obama signed into law the legislation necessary to temporarily prevent the scheduled Medicare SGR related payment cut for physicians and other practitioners from taking effect on January 1, 2012.  The cut is effectively rescheduled to take effect on March 1, 2012 if Congress doesn't act to move the date out again or legislate a permanent fix .

Budget Neutral Conversion Factor

While the physician fee schedule update is zero percent, other changes to the relative value units (RVUs) used to calculate the fee schedule rates must also be budget-neutral.  According to a CMS press release, "To make those changes budget neutral, the conversion factor must be adjusted for 2012 ."  CMS has issued the new 2012 Medicare Physician Fee Schedule (MPFS) implementing the zero percent update for the period of January 1, 2012 to February 29, 2012.

No Need to Hold New Claims

CMS previously announced that it was directing its contractors to hold new 2012 claims for up to 10 business days to test and implement the new 2012 MPFS.  These claims were released into processing as of January 18, 2012.

Other Changes and Postponements from . . .

CMS and Congress implemented several other significant changes and postponements of policies that took effect on January 1, 2012.   The new legislation . . . 

1.  . . . extends the geographic payment adjustments to reflect differences in the cost of practice in different geographic areas for physician work, practice expense, and malpractice expense.  The new legislation extends the existing 1.0 floor on this index through February 29, 2012.

2.  . . . increases the payment amount for the initial and annual wellness visit (which has no cost sharing for patients) to account for the introduction of health risk assessment (HRA).  In 2012, CMS will also allow for variation in the content of the HRA.

3.  . . . extends the 2011 five percent payment increase for certain mental health services through February 29, 2012.

4.  . . . extends the 10 percent incentive payment for primary care services under Medicare Part B (which are paid in addition to physician incentive payments for services furnished in Health Professional Shortage Areas).  

5.  . . . extends the exceptions process for outpatient therapy caps .  Providers may submit claims with the KX modifier for services furnished through February 29, 2012. 

6.  . . . temporarily restores a moratorium on proposed legislation which would allow payment only to hospitals (not physicians or independent labs) for the technical component of physician pathology services furnished to hospital patients.  Eligible independent laboratories may continue to submit claims to Medicare for the TC of physician pathology services through February 29, 2012.

7.   . . . extends the following through February 29, 2012:

A.  . . . a three percent increase in ambulance fee schedule amounts for ground ambulance transports originating in rural areas and a 2 percent increase in urban areas;

B.  . . . the provision regarding air ambulance services that considers any areas designated rural as of December 31, 2006 continues to be treated as rural  for purposes of making payments; 

C.  . . . the provision increased ground ambulance services payment rates that orginate in areas that comprise the lowest 25th percentile of all rural populations.

8.  . . . extends the Outpatient Hold Harmless provision to rural hospitals with 100 or fewer beds and all sole community hospitals and Essential Access Community Hospitals. 

9.   . . . extends the 2011 payment rate for bone mass measurement through February 29, 2012.

All of these changes and extensions are reflected in the revised 2012 MPFS .

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To find out how PBN can help you guide your practice through these and upcoming changes, contact . . .

PBN Business Development, 800.288.4901 or 

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Overland Park, KS 66210 | 800.288.4901 | pbnmed.com

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