CMS Announces Final Rates, Rules for 2010 Outpatient and Physician Services
November 3, 2009
The Centers for Medicare and Medicaid Services (CMS) has posted the final calendar year 2010 Medicare rules and rates for hospital outpatient and physician services. The new policies are scheduled to go into effect on January 1, 2010.
Physician Services
Payments under the physician fee schedule will be reduced by 21.2 percent in 2010, unless Congress once again acts to halt this formula-driven reduction mandated by current law. Legislation to do so is under consideration. Other major policies in the rule announced by CMS include:
- CMS will incorporate the results of the American Medical Association’s new Physician Practice Information Survey (PPIS) survey data into its formula used to calculate the practice expense relative value units (RVUs). This will significantly reduce payments for many diagnostic imaging and cardiovascular related services. This will be phased-in over four years.
- CMS will increase from 50 to 90 percent the equipment utilization rate assumption used in the formula to determine the technical payments for MR and CT services. This change also will be phased in over four years. CMS said it will not apply this change to radiation oncology or cardiac catheterization equipment, as it had originally proposed.
- CMS is implementing a 2008 requirement passed by Congress that suppliers of the technical component of advanced imaging services be accredited beginning January 1, 2012. The accreditation requirement will apply to mobile units, freestanding imaging centers, physicians’ offices, and independent diagnostic testing facilities.
- CMS is adding new quality measures for use under the Physician Quality Reporting initiative.
Hospital Outpatient Departments and Ambulatory Surgery Centers
CMS announced that most hospitals will receive an inflation update of 2.1 percent in their payment rates for services to Medicare beneficiaries in outpatient departments. Those hospitals that did not participate in quality data reporting for outpatient services, however, will receive an update of only 0.1 percent. Other major policies announced by CMS include:
- CMS will continue to require hospitals to report on the existing seven emergency department and surgical care quality measures, as well as the four existing claims-based imaging efficiency measures to receive the full 2011 payment update.
- Hospitals will be able to bill Medicare for new pulmonary and intensive cardiac rehabilitation services furnished in hospital outpatient departments.
- CMS will provide payment to rural hospitals for kidney disease education services they furnish via their outpatient departments to patients with Stage IV chronic kidney disease.
Ambulatory surgical centers will receive a 1.2 percent inflation update beginning January 1, 2010, bringing total payments to the 5,000 ASCs in the U.S. to about $3.4 billion. CMS will pay for an additional 26 surgical procedures performed in ASCs.
Find the regulations for outpatient/ASC payment and the physician fee schedule. (Once at the Federal Register page, please scroll down to the Centers for Medicare and Medicaid Services.)
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