WASHINGTON – Physicians have until February 15 to decide whether they will participate in the nation's Medicare program. The new cutoff date gave practices an additional 45 days beyond the original deadline of Dec. 31, 2007.
Physicians must commit to participate if they wish to treat Medicare-covered patients and take assignment, which means they accept Medicare-approved amounts for their services. Medicare pays 80 percent of the Medicare-approved amount, with the remainder the responsibility of the patient or the secondary insurer.
Physicians also can choose not to participate in Medicare, which means they can still treat patients covered by Medicare, but face limits on how much they can charge and other regulations.
The decision to participate this year may be complicated by uncertainty surrounding the future of physician payment rates. Before 2007 ended, President Bush signed the Medicare, Medicaid and SCHIP Extension Act of 2007; a provision of that act replaced the 10.1 percent reduction in Medicare Part B payments scheduled for 2008 with a six-month, 0.5 percent increase. Physicians could face the prospects of a reduction in Part B payments in July, unless Congress intervenes or existing methodologies for calculating payment rates are scrapped.
"The update may affect the physicians' decision to participate," said Ellen Griffith, public affairs specialist for the Centers for Medicare & Medicaid Services. "That's why we gave them an extension."
If physicians participate in Medicare for 2008, they will receive the positive update for the first six months and will have to hope that Congress will act to override cuts called for in the sustainable growth rate formula. Congress has been granting extensions to override SGR cuts since 2003.
In addition to temporarily averting the cut, the act requires CMS to adjust the average sales price calculation to use volume-weighted ASPs based on actual sales volume and institutes a reimbursement rate for generic albuterol.
Information from the Medical Group Management Association noted that 2008 marks the second year in a four-year transition to revise practice-expense relative value units. A number of services have revised RVUs for physician work, with several increasing significantly.
CMS has increased the budget-neutrality adjustment created last year to compensate for changes to the five-year review of work values; payments for many services will drop by about 1 percent, MGMA indicated.