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Congress approved a two-month extension of the payroll tax cut; the bill also delays a 27% cut in Medicare payments. Without this legislation, physicians faced a 27 % reduction in Medicare payments in 2012.

This bill is a short-term proposal that maintains current payment rates through February 29, 2012. Both chambers will then send negotiators to hammer out a yearlong package in early 2012 for the Sustainable Growth rate (SGR) formula, payroll tax cut, and unemployment benefits.

The Medical community continues to let Congress know that that these short term fixes creates uncertainty and instability in the medical community, and failing to adopt a real, long-term answer to the SGR will only lead to even more significant costs later.

BCBS of Florida Requires Accreditation for Payment of Advanced Imaging Services

Effective January 1, 2012, accreditation through either the American College of Radiology (ACR) or Intersocietal Accreditation Commission (IAC) will be a Blue Cross and Blue Shield of Florida, Inc. (BCBSF) requirement for receiving payment for advanced imaging services. Consistent with this requirement, effective January 1, 2012, National Imaging Associates (NIA) will not issue pre-authorization or voluntary pre-service coverage review (VPCR) to physicians or freestanding diagnostic centers who have not received accreditation. This is applicable to office-based physicians and freestanding diagnostic centers rendering the technical or global components for advanced imaging services.

PFS and HOPPS Final Rules and The Impact on Echocardiography

The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period that updates payment policies and rates for physicians and non-physician practitioners for services paid under the Medicare Physician Fee Schedule (MPFS) in calendar year (CY) 2012. More than 1 million providers of health services to Medicare beneficiaries are paid under the MPFS. CMS projects that total payments under the MPFS in CY 2012 will be approximately $80 billion.

The final rule again projects a steep across-the-board reduction in payment rates, based on a formula - the Sustainable Growth Rate (SGR) formula - that was adopted in the Balanced Budget Act of 1997. Without a change in law, Medicare payment rates for services in 2012 are projected to be reduced by 27.4 percent, less than the 29.5 percent reduction that CMS had estimated in March of this year because Medicare cost growth has been lower than expected.

"This payment rate cut would have dire consequences that should not be allowed to happen," said Donald M. Berwick, M.D., CMS administrator. "We need a permanent SGR fix to solve this problem once and for all. That's why the President's Budget and his Plan for Economic Growth and Deficit Reduction call for permanent, fiscally responsible reform and why we are committed to working with the Congress to achieve a permanent and sustainable fix."

The rule includes having payment rates for the professional component of advanced imaging services provided by the same physician on the same day be reduced by 25 percent for the second service. CMS had proposed to reduce these payments by 50 percent in the proposed rule released in July. Currently this does not apply to echocardiography. However, CMS indicates that it will consider reductions for other services provided by the same physician on the same day in the future.

Under the final PFS, Relative Value Units for TTE with spectral and color Doppler will be reduced by 9% (global); 5% (PC only); 11% (TC only).

The final rule with comment period updates a number of physician incentive programs including the Physician Quality Reporting System, the e-Prescribing Incentive Program and the Electronic Health Records Incentive Program. It includes quality and cost measures that will be used in establishing a new value-based modifier that would reward physicians for providing higher quality and more efficient care. The Affordable Care Act requires CMS to begin making payment adjustments to certain physicians and

physician groups on January 1, 2015, and to apply the modifier to all physicians by January 1, 2017. CMS intends to work closely with physicians to ensure that efforts to improve the quality, safety, and efficiency of care do not have unintended consequences for patient access to care.
For more information please go to:

http://connect.asecho.org/ASECHO/ASECHO/Go.aspx?c=ViewDocument&DocumentKey=50ae5a77-0d52-46c5-ad24-05a591c78e78

CMS also issued a final rule with comment period (final rule) that will update payment policies and rates for both hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for calendar year (CY) 2012. The final rule seeks to promote higher quality and more efficient services for Medicare beneficiaries.

CMS projects that total payments for services furnished to people with Medicare in HOPDs during CY 2012 under the Outpatient Prospective Payment System (OPPS) will be approximately $41.1 billion, while total projected CY 2012 payments under the ASC payment system will be approximately $3.5 billion.

1. Under the HOPPS, APC rates for TTE with spectral and color Doppler (CPT 93306) will decline by less than it would have under the proposed rule ( -2% rather than -5%).

2. Medicare payment for fetal echo will increase by over $330, as the result of reclassification of fetal echo into the same APCs used for adult echo, and this change resulted from an ASE initiative.

3. CMS rejected ASE’s request for the establishment of additional contrast-enhanced echo APCs, but increased the APC rate for contrast-enhanced echo by almost $60. Under the final rates, the APC rate for contrast enhanced TTE (with spectral and color Doppler) is $164.10 more than unenhanced procedures but the APC rate for contrast-enhanced stress echo is $23.68 less than for unenhanced stress echo.
For more infomation please go to:

http://connect.asecho.org/ASECHO/ASECHO/Go.aspx?c=ViewDocument&DocumentKey=6ba6899c-e7e2-46d2-b91e-640ad84700e5

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Delay of Medicare 27% Cuts