Physicians now have until Feb. 15 to decide whether they will participate in the nation's Medicare program. The new cutoff date gives practices an additional 45 days beyond the original deadline of Dec. 31, 2007, to make their decision.
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 to not 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 the uncertainty surrounding the potential future of physician payment rates this year. This past Saturday, 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 choose to 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 (ASP) calculation to use volume-weighted ASPs based on actual sales volume and institutes a reimbursement rate for generic albuterol.
Among other provisions, the Medicare, Medicaid and SCHIP Act of 2007 also extends SCHIP at current funding until March 31, 2009, and the five percent bonus payment to physician shortage areas through June 30.
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. These values increase 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.
The geographic adjustment factors (GPCIs) also have been updated. In addition, the law just passed by Congress continued the floor on the work GPCI and physician-scarcity area bonuses until June.