Final Rule for the Medicare 2009 Physician Fee Schedule
The 2009 Medicare Physician Fee Schedule Final Rule was released in draft form on October 30, 2008, and the official version appears in the November 19, 2008 Federal Register. The Federal Register version is available at the Government Printing Office website, www.gpoaccess.gov/fr.
The Proposed Rule (published July 7) contained several provisions that would have negatively impacted many physician practices, including requiring physician offices performing diagnostic imaging to enroll as Independent Diagnostic Testing Facilities (IDTF), and updates to the Physician Self-Referral and Anti-Markup issues.
In the Final Rule, however, we were pleased to see that CMS did not adopt some of the more narrow guidelines they were considering in the Proposed Rule related to Diagnostic Imaging.
Specifically, the Final Rule:
- Does not require all physician offices providing Diagnostic Imaging to enroll as an Independent Diagnostic Testing Facility (IDTF). CMS appears to be relying on future accreditation requirements (2011 or 2012) to address their concerns in this area.
- Does require mobile diagnostic testing entities to enroll as IDTFs and to bill Medicare directly. This will disrupt many practices utilizing mobile MRI services, for example. There are exemptions for hospital-based mobile services.
- Clarifies the "anti-markup" rules with respect to diagnostic testing in a manner that should accommodate many existing "in office" imaging joint ventures. The proposed rule provisions would have required some form of restructuring or "unwinding" for many of these ventures. The new "anti markup" rules are fairly comprehensive and should be reviewed by any group involved in a diagnostic testing joint venture to ensure compliance. These rules are effective January 1, 2009, with no grace period or extension of time for compliance.
In addition, the Final Rule:
- Makes significant changes that impact the ability to retroactively bill Medicare for services provided by a physician new to a group while waiting on CMS to process a new enrollment application. The old "grace period" of over two years is now 30 days prior to the date of filing of a "clean" Medicare provider enrollment application or the date a provider began furnishing services at a new practice location.
- Does not address "incentive payment" and "shared savings programs" (gainsharing) but seeks additional comments on these areas.
- Provides for an overall 1.1% increase for 2009 (impact varies by specialty) versus the previously scheduled decrease of 15.1%.
- Applies the "Budget Neutrality" factor to all RBRVS components versus just the Work component. This results in about a 12% effective increase to Work relative values, offset by reductions across all components. As a result, procedures that are more "work component" weighted increase by more than 1.1% (such as E&M codes).
The above is only a summary of some key provisions of the Final Rule and is not intended as legal advice or a thorough description of the Final Rule. Please review any potential impact with appropriate advisors or council.
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