On July 1, the Centers for Medicare & Medicaid Services (CMS) released a display copy of the proposed rule for the proposed changes to policy and payment for the Physician Fee Schedule for 2012.  If implemented, changes outlined in the proposed rule will significantly affect sleep physicians. 

One of the more significant proposed changes is the acceptance of a new measures set for sleep apnea in the Physician Quality Reporting System (PQRS) program.  If approved in the final rule, the addition of these new quality measures will allow sleep physicians to participate in the PQRS program and potentially earn an incentive of 0.5 percent of allowable charges for successful participation.

A lingering concern from the 2011 final rule is the issue of the conversion factor, which helps determine payment for all physician services.  The proposed rule estimates that, with the current formula CMS is legally mandated to use, the conversion factor will be $23.9635.  This would be a cut of almost 30 percent.  In the display copy of the proposed rule, CMS explains that it is working with Congress on a solution to the legally required reductions in the conversion factor.

AASM staff will continue to analyze the proposed rule and will provide additional information in future editions of Coding Corner.  The display copy of the proposed rule will be available until it is replaced by a version that will be published in the Federal Register on or after July 8.  The AASM also will watch for the final decisions on the proposed policy and payment changes, which are scheduled to be published in November 2011 in the final rule.

For more information, see the Fact Sheet about the proposed rule on the CMS website.  Coding Corner articles are archived on the Coding Page of the AASM website for future reference.