SUBJECT:   2009 Medicare Physician Fee Schedule

Key provisions of the final 2009 Medicare physician fee schedule 

The Centers for Medicare & Medicaid Services (CMS) released the 2009 final Medicare physician fee schedule on Oct. 30. In this rule, CMS has made a variety of policy changes that significantly affect physicians. The final rule:

• Replaces the previously proposed 15.1 percent cut to Part B services with an overall 1.1 percent increase for 2009.
• Shifts and recalculates the budget-neutrality adjustor. The effect is an approximate 6 percent reduction to the conversion factor and 12 percent increase to physician work values. While the conversion factor will fall from $38.09 in 2008 to $36.07 in 2009, overall average payments will increase by 1.1 percent as mandated by law. This change returns $200 million in savings to the physician spending pool from previously mandated cuts in imaging payments. 
• Extends the work Geographical Practice Cost Index (GPCI) floor and the therapy cap exception process through Dec. 31, 2009.
• Increases the Physician Quality Reporting Initiative (PQRI) bonus incentive to 2 percent for 2009 and 2010. In 2010, CMS will post the names of successful 2009 PQRI participants on a CMS Web site. 
• Implements a five-year program of incentive payments for e-prescribing and extends the current e-prescribing fax exemption until Jan 1, 2012.
• Significantly curtails the ability of medical practices to retroactively bill Medicare for services provided while enrollment applications are pending. Instead, practices will now only be able to bill for 30 days prior to the later of:
  • The date of filing of a Medicare provider enrollment application that was subsequently able to be processed by a Medicare contractor; or
  • The date a provider began furnishing services at a new practice location.
• Adds two HCPCS (Healthcare Common Procedure Coding System) codes for follow-up inpatient telehealth consultation.
• Does not finalize a proposal requiring physician offices to enroll in Medicare as independent diagnostic testing facilities (IDTFs).
• Requires mobile diagnostic testing entities to enroll as IDTFs and to bill Medicare directly for services (except entities furnishing services under arrangement with a hospital).
• Extends the comment period for CMS to consider an exception to the physician self-referral (Stark) law that would allow incentive payments and shared savings programs.
• Expands the "anti-markup" Medicare billing rule to apply to diagnostic testing services performed by a physician who does not share a practice with the billing physician or group, which includes applying the rule to certain tests performed inside a group practice when the performing physician: 

• Does not perform 75 percent of his/her professional services through the billing physician or group; and 
• Does not perform the tests in a location where the ordering physician provides substantially the full range of patient care services he/she provides generally.
• Discontinues reimbursement for continuous positive airway pressure (CPAP) devices when the supplier is directly or indirectly providing the sleep test used to diagnose the beneficiary with obstructive sleep apnea (except for attended facility-based polysomnograms).

Source for the above: MGMA

On Nov. 3, 2008, CMS published the 2009 RBRVS Relative Values along with the 2009 Geographical Practice Cost Indeces (GPCIs) for Connecticut for work, practice expense and malpractice insurance.  These data, when combined in a national formula using the national 2009 Medicare Conversion Factor of $36.0666, permit the 2009 Connecticut Medicare fees to be calculated.

MPS has done this database work and has calculated the entire 2009 Connecticut Medicare physician fee schedule.  This 2009 Connecticut Medicare physician fee schedule will be placed on the MPS website (www.mpsphysicians.com) in the near future.

MPS encourages all MPS physicians to take advantage of the increases in the Physician Quality Reporting Initiative (PQRI) bonus incentive to 2 percent for 2009 and 2010.   Certain EHRs and registries (i.e. DocSite) can assist you in reporting PQRI data to CMS.

The 2009 Medicare Physician Fee Schedule also implements a five-year program of incentive payments for e-prescribing and extends the current e-prescribing fax exemption until Jan 1, 2012.  MPS encourages all MPS physicians to take advantage of these e-prescribing incentives.