AAN Summary and Analysis: 2011 Medicare Physician Payment Proposed Rule

July 2, 2010

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed regulation detailing Medicare physician payment policies for 2011. AAN is providing a summary of issues most of interest to neurology. The rule implements several provisions of the Affordable Care Act (ACA.) AAN is conducting a thorough analysis of the rule and will submit an extensive comment letter before the August 24, 2010, deadline.

Consultation Codes

CMS is asking for the perspectives of physicians about the effects of the elimination of the reporting of consultation codes. AAN will continue to share data with CMS about the negative effects on neurology practices and advocate for improved policies.

Canalith Repositioning

Neurologists see a victory with CMS proposing to pay for CPT code 95992 [Canalith repositioning procedure(s) (e.g., Epley maneuver, Semont maneuver), per day]. Since the code was established in 2009, the AAN has been advocating that CMS recognize the distinct and separate nature of this procedure from an E/M service and recognize the code for payment.

Incentive Payments for Primary Care Services

CMS lays out the method for instituting a 10 percent bonus payment to primary care physicians who provide at least 60 percent of their charges to E/M codes. While Neurology is not currently an eligible specialty, the AAN continues its legislative and regulatory efforts to allow neurologists to qualify.

Medicare Economic Index (MEI)

CMS is proposing to rebase the Medicare Economic Index to use more current data. The MEI is used with the SGR to update the physician fee schedule. CMS is also proposing to convene a technical advisory panel later this year to review all aspects of the MEI and is requesting comments from the physician community on any other specific issues that should be considered by the technical panel.

Physician's Quality Reporting Initiative (PQRI)

The incentive program for participation in the PQRI is extended to 2014, with penalties starting in 2015. Instead of having to report claims based submissions 80 percent of the time as has been required previously, CMS is proposing to reduce the requirement to 50 percent. Registry and EHR requirements remain at 80 percent for 2011.

In accordance with the Affordable Care Act, CMS is proposing to offer an additional incentive from 2011-2014 for those who successfully report under the PQRI. To qualify for this payment, participants would be required to submit their data through a Maintenance of Certification Program (MOCP) and participate in a MOC practice assessment more often than is required to maintain board certification.

E-Prescribing

Neurologists can continue to earn a one percent incentive payment in 2011 for reporting e-prescribing measures for at least 25 visits. CMS proposes physicians who do not participate in the 2011 e-prescribing incentive program would be penalized in 2012.

Potentially Misvalued Services

CMS requests that the Relative Value Update Committee (RUC) review several categories of services that may be misvalued. The list includes certain common neurology codes such as motor and sensory nerve conduction studies (95900 and 95904). AAN will ensure strong data is presented in the review of these services.

Medicare Telehealth Services for the Physician Fee Schedule

CMS is proposing to add subsequent hospital care services to the list of telehealth services for 2011, but with a limitation on the frequency that these services may be furnished through telehealth to once every three days.

CMS is also proposing to expand the list of telehealth services to neuropsychological testing.

Extension of Physician Fee Schedule Mental Health Add-On

The proposed rule extends the current 5 percent increase in Medicare payment for specified mental health services to be effective through December 31, 2010.

Imaging

CMS outlines at least two proposals that may have a negative impact on neuroimagers.

1. Equipment Utilization Assumption.

The rule finalizes provisions in the health reform law that require CMS to use a 75 percent equipment utilization assumption for high cost imaging services beginning January 1, 2011. This will mean lower practice expense (PE) values for certain CT and MRI services.

2. Disclosure Requirements for In-Office Ancillary Services.

Starting January 1, 2011, the rule also finalizes requirements in the health reform law that call for physicians who perform PET, CT or MRI in the office to inform the patient in writing at the time of a referral for these services that the patient may obtain the same service from another supplier. CMS proposes that the list of other suppliers need only be suppliers located within a 25-mile radius of the physician's office, regardless of where the patient lives. Further, the list should include at least 10 other suppliers, unless there are fewer than 10 in the area.

Therapy Caps

CMS's authority to provide for exceptions to therapy caps (independent of the outpatient hospital exception) will expire on December 31, 2010, unless the Congress acts to extend it; and CMS is committed to finding alternatives to the current therapy cap limitations on expenditures for outpatient therapy services that will ensure that beneficiaries continue to receive those medically necessary therapy services that maximize their health outcomes. In the proposed rule, CMS seeks comments on three alternative exceptions processes.

Impacts

The overall impact to neurology will be a 1 percent increase in allowed charges based on changes to RVUs and MEI rebasing. This does not take into account scheduled cuts to the conversion factor.

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