WASHINGTON – The Centers for Medicare and Medicaid Services has proposed new efforts to promote access to higher-quality and more efficient healthcare for Medicare beneficiaries under the 2009 Medicare Physician Fee Schedule.
The MPFS was created by Congress and is updated annually to set the Medicare payment rates for more than 980,000 physicians and non-physician practitioners (NPPs) who bill Medicare for the services they furnish to beneficiaries.
According to officials, under a formula in the Medicare statute, CMS is required to reduce the 2009 MPFS by 5.4 percent. Total Medicare spending under the 2009 MPFS is projected at $54 billion, down 5 percent from the $57 billion projected for 2008.
It is reported that nearly 95 percent of physicians enrolled in Medicare accept the fee schedule rate as payment in full. Medicare pays 80 percent of the fee schedule rate, while the beneficiary is responsible for the remaining 20 percent.
“CMS has been carefully monitoring beneficiary access to physicians’ services,” said Acting CMS Administrator Kerry Weems. “To date, our studies, as well as studies by the Medicare Payment Advisory Commission, reveal that beneficiaries in most areas of the country are having little or no trouble in seeing their physicians and we expect this to continue in 2009.”
CMS is proposing additional improvements to the Physician Quality Reporting Initiative (PQRI), which allows eligible professionals to report quality measures relating to their clinical practice.
A proposal has also been made to improve the quality of diagnostic testing performed by physicians and NPPs in their offices by requiring them to enroll as suppliers of these services. They would then have to meet certain quality and performance standards, including applicable federal and state licensure, health and safety requirements, that currently apply to independent diagnostic testing facilities (IDTFs).
CMS suggests that these standards become effective Jan. 1, 2009 for newly enrolling suppliers, but would allow existing suppliers until Sept. 30, 2009 to come into compliance.
The proposed fee schedule also addresses a change to the exemption that limits the use of computer-generated faxes to e-prescribe Part D covered drugs for Part D-eligible individuals to instances in which temporary/transient transmission failure or communication problems preclude the sue of the adopted NCPDP SCRIPT standard. This change is scheduled to take effect on Jan. 1, 2009.