Last week the AASM announced that the Centers for Medicare & Medicaid Services (CMS) had published the 2012 Physician Fee Schedule Proposed Rule in the Federal Register; please note that this is the draft rule and is not final. If implemented, changes outlined in the proposed rule will significantly affect sleep physicians.
Previously, the AASM reported that the Proposed Rule accepts a new measures set for sleep apnea in the 2012 Physician Quality Reporting System (PQRS) program, which would enable sleep physicians to earn incentive payments by participating in the program. The Proposed Rule also estimates that in 2012 the conversion factor will be reduced by almost 30 percent if Congress fails to find a solution to the sustainable growth rate (SGR) that will affect payment formula.
Further analysis shows that CMS has proposed to maintain the 2011 physician work relative value units (RVUs) for the sleep medicine codes in 2012. However, CMS has proposed to change all of the practice expense RVUs for sleep medicine codes in 2012.
Practice expense payment for several sleep codes is proposed to increase modestly by one to three percent, with code 95807 scheduled for the largest increase of 5.5 percent. However, payment reductions of between six and 27.5 percent are proposed for codes 95800, 95801, 95810 and 95811. The AASM has reached out to the American Medical Association (AMA) to help clarify the proposed reductions and will be following up directly with CMS as well. Clarification will be reported to members when it is available from the AMA and CMS.
More information about the Proposed Rule will be provided by the AASM in future editions of the Coding Corner. The 2012 Physician Fee Schedule Final Rule, which will outline final decisions on policy and payment changes for 2012, is scheduled to be published in November 2011.