CMS Unveils Medicare Physician Fee Schedule Proposed Rule: New Disclosure Requirements Clarified
On June 25, 2010, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update payment policies and Medicare payment rates for services furnished by physicians and non-physician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The 1,250 page rule is now on display at the Office of Federal Register and is slated to be published in the July 13, 2010 Federal Register with a 60 day period for comment. CMS will respond to comments in the final rule which is expected to be issued on or about November 1, 2010. The payment policies and rates that are adopted in the final rule will be effective for services on or after January 1, 2011.
In general, the rule addresses suggested changes to the physician fee schedule and other Medicare Part B payment policies and specifically ensures that the CMS payment systems are updated to reflect changes in medical practice and the relative value of services. While several of these provisions directly affect payments provided under the MPFS, the proposed rule also focuses on several policies that are not directly related to physician payment rates. In fact, the rule implements a number of key provisions of the recent health reform legislation, the Patient Protection and Affordable Care Act (PPACA), including guidance on complying with the Stark requirements for specific physician-owned imaging services. In proposing guidance to effectuate the disclosure requirements under PPACA, CMS recommended and solicited comments on different aspects of these requirements applicable to physician practices providing imaging services within the in-office ancillary services exception.
Under Section 6003 of PPACA, CMS must promulgate a requirement that the physician referring a patient for magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), or any other designated health service (DHS), must inform a patient in writing at the time of the referral that the patient may receive the service outside the physician’s group and simultaneously furnish the patient with a list of suppliers in the area. CMS is considering whether to expand the list of applicable diagnostic procedures to other radiology and imaging services.
Under the proposed rule, CMS offers some qualification for this broad disclosure provision. The rule proposes that referring physicians provide the patient with a list of at least 10 suppliers who should be located within a 25-mile radius of the physician’s office at the time of the referral. And, only “suppliers” need to be included in the list of alternatives for receiving such services. A “supplier” means a physician or other practitioner, or an entity other than a provider, that furnishes health care services under Medicare. Therefore, hospitals and other types of providers are not required to be disclosed. The list for each alternative supplier must include the name, address, phone number and distance from the physician’s office. PPACA mandates that CMS implement this disclosure provision effective January 1, 2010. However, CMS interprets the provision to allow it to establish the effective date by regulation which would make the new disclosure requirements applicable to services furnished on or after the effective date of January 1, 2011.