Further Update on CMS Final Payment Rules

December 28, 2009

Further Update on CMS Final Payment Rules

As we have previously reported to our members, the Centers for Medicare and Medicaid Services (CMS) issued two final rules, one for physician payment (Medicare Physician Fee Schedule [MPFS]) and the other for hospital procedures (Hospital Outpatient Prospective Payment System [HOPPS]). Since our first notice, SNM has been working to try to alleviate some of the reductions for reimbursement of imaging procedures. We have also been monitoring activities in Congress and at CMS, and will be taking action as we move into 2010.

  1. Request Delay in Implementation of PPIS
    SNM has written a letter to CMS requesting that the agency delay the implementation of the AMA Physician Practice Information Survey (PPIS). We believe the survey data were not representative of the actual practice expenses for nuclear medicine, and their use could have a profound negative impact on the calculation of practice expenses for nuclear medicine and other imaging services.
  2. Request Technical Correction for Physician Work Valuation for MPI Codes, and Request Phase-In for Cuts to Payment for MPI Codes
    SNM, together with the American Society of Nuclear Cardiology (ASNC) and the American College of Radiology (ACR) met with CMS staff to discuss two major concerns that we have with the MPFS final rule. The discussion focused on two specific topics: a request for a technical correction for work valuation for myocardial perfusion imaging (MPI) codes and a phase-in of the AMA PPIS for MPI codes.

    First, the societies asked CMS to accept the AMA RVS Update Committee's (RUC) recommendations on practice work relative value units (RVUs) for the recently bundled MPI codes (for more information on these codes, please click here). While all three societies will be discussing these concerns in formal written comments to CMS, and will request CMS convene a refinement panel – which we will ask to participate in – to seek a change for the practice work RVUs, all felt that it was necessary to raise this concern with CMS prior to January 1, 2010.

    Second, the societies raised the issue of CMS's decision not to apply the four-year phase-in for cuts to the bundled MPI codes. In the final rule, CMS treated these new bundled codes as "new or significantly revised", and therefore determined that they would not be subject to the phase-in afforded to other established codes. During the meeting, the societies stressed that the MPI codes are not new procedures, in fact, these procedures have been in use for more than 20 years. Additionally, the description of the bundled codes is identical to the descriptions the individual codes have held in past years. Therefore, the codes are not new, but are revised bundled codes. The societies further emphasized that should CMS elect to treat these bundled codes as new procedures, the agency will be setting a precedent for all future medical procedures which face the bundling process.
  3. Submit Comments to CMS on the MPFS and HOPPS Final Rules
    SNM is finalizing its comments to CMS on both the MPFS and HOPPS final rules. These comments will include discussion on the above issues, as well as transitional pass through diagnostic radiopharmaceuticals, packaging diagnostic radiopharmaceuticals, ASP reporting for therapeutic radiopharmaceuticals and supervision requirements.
  4. The President Signs a Short-Term Fix to the Sustainable Growth Rate
    Major reductions loom for reimbursement of imaging procedures if Congress does not lift implementation of the Sustainable Growth Rate (SGR) rule which would cause an across-the-board 21.5% decrease in payment for physician services beginning in January 2010. (For more information on the SGR, please click here.)

    Both the House and the Senate have passed a short-term fix to the SGR which would freeze Medicare physician payments at the 2009 rate for two months. SNM is pleased that the President has signed a short-term fix into law, but cautions that it is not enough to ensure that physician payment rates do not continue to be reduced at alarming rates. In November, the House approved a permanent fix to the payment formula, however the Senate refused to debate similar legislation citing concerns that it would add to the deficit.
  5. Representative Gonzalez Introduces a Bill to Continue Using 2009 Medicare Practice Expense Relative Value Units for Certain Cardiology Services
    On December 16, 2009 Representative Gonzalez (D-TX) introduced a bill to continue using 2009 Medicare practice expense relative value units for certain cardiology services. This bill would delay the implementation of the PPIS survey data for codes relating to nuclear cardiology (CPT 78451-78454). While SNM supports this legislation, we feel that there is a broader problem that affects other specialties, not just nuclear cardiology. SNM is formulating a legislative course of action to address the broader issue.

We will continue to provide updates, and may call on our membership to help influence Congress as we begin 2010. Please continue to monitor the SNM website for further information.