Your Medicare payments will fall by 27.4% in 2012, under a conversion factor of $24.6712, which is slightly less than the 29.5% cut projected by CMS earlier under the sustainable growth rate (SGR) formula. The difference is due to Medicare costs growing slightly slower than expected, the agency says.
Of course, this 27.4% cut isn’t the final word, because Congress has always stepped in at the last minute to avert SGR cuts. “This payment rate cut would have dire consequences that should not be allowed to happen,” CMS Administrator Donald Berwick, MD, said in a press release that accompanied the fee schedule final rule. “We need a permanent SGR fix to solve this problem once and for all.”
Here's a brief look at the top three changes you'll face in January:
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Annual wellness visit changes. You must comply with specific new criteria for a health risk assessment (HRA) which will become part of the annual wellness visit (AWV) in 2012, though CMS is also “modestly” increasing payments for the AWV to account for the increase in staff time needed. The HRA requires you to collect patient-reported data, which the patient can fill out before the AWV or during the service by staff. The HRA must include a lengthy list of health details, such as life satisfaction, tobacco use, physical activity, alcohol consumption, sexual health and seat belt use.
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More relaxed MPPR cuts.You will only get paid 75% of the reimbursement rate for the professional component of multiple imaging services on the same patient in the same day. You will get paid the full rate for interpreting the first image and see a 25% cut, instead of the proposed 50% reduction, to all subsequent image interpretations, CMS writes.
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Higher e-Prescribing (e-Rx) requirements.Group practices with 25 to 99 providers must successfully e-Rx 625 times in 2012 and 2013 to get the incentive payment and practices with more than 100 providers now have to report 2500 times, CMS writes in the rule. Also, CMS is now prohibiting double payments for physicians associated with large group practices. You will only get one incentive payment for e-Rx individually or as a member of the group practice.
Look for comprehensive coverage of the 2012 final rule online at www.partbnews.com on Friday, and in the next print issue as well.