CMS Proposes 2012 Changes to Payment Policy and Rates

02 Jan

The Centers for Medicare & Medicaid Services (CMS) has made public their proposed rules that will affect doctors, hospital outpatient departments (HOPD), ambulatory surgical centers (ASC), and suppliers of renal dialysis services in 2012.

Highlights from the proposed rule changes include updates to payment policies and rates for 2012 and measures being taken to continue to implement the provisions of the Affordable Care Act meant to improve the quality of care, but also reduce government spending.

Under the law as it is today, Medicare payment rates for physician services face a 29.5 percent reduction in 2012 based on the Sustainable Growth Rate (SGR) formula. Along with other advocates, CMS is against this reduction, which means it is unlikely that physicians will receive such a drastic pay cut.

“Today, the Centers for Medicare & Medicaid Services (CMS) issued proposed rules that spell out how this cut is calculated and warned that if Congress does not act in time, doctor fees will be slashed come January 1. We cannot – and will not – let this happen,” wrote CMS Administrator Donald Berwick, MD on

The Medicare Physician Fee Schedule rule proposed for next year would also update a number of physician incentive programs, including the Physician Quality Reporting System, the e-Prescribing Incentive Program, and the Electronic Health Records Incentive Program.

You can view the proposed changes to these physician incentive programs over at the
Centers for Medicare & Medicaid Services website. Some of the highlights include:

– Expansion of its multiple procedure payment reduction to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services

– Revision of the criteria for a health risk assessment (HRA) to be used in conjunction with annual wellness visits (AWVs)

– Expanding of the list of services that can be furnished through Telehealth to include smoking cessation servicesRevisions to the quality and cost measures that would be used in establishing a new value-based modifier that would reward physicians for providing higher quality and more efficient care.

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