The Centers for Medicare & Medicaid Services (CMS) on July 13 published the proposed 2011 Medicare Physician Fee Schedule in the Federal Register. This rule includes both the standard annual update to the Medicare payment schedule and implementation of many provisions of the Affordable Care Act. The American Medical Association (AMA) has prepared a detailed summary of the rule; please note that it does not touch on every element within the 1,250-page proposed rule.
2011 Medicare Physician Fee Schedule
It is important to note this rule is proposed and not final. The final rule for the 2011 Medicare Physician Fee Schedule will likely be published in a November edition of the Federal Register. Of further note, information and numbers included in this proposed rule may and will likely change before publication of the final rule.
This proposed version of the 2011 Medicare Physician Fee Schedule details the proposed cost share weights for practice expense, professional liability insurance (PLI) and physician work. The rule provides an increase to the proportion of aggregate physician fee service payments for practice expense (PE) and PLI and a decrease to the proportion for physician work. CMS indicates the decrease to physician work is necessary to achieve budget neutrality. Additionally, please note these adjustments are across all specialties and not exclusive to sleep medicine.
Again, this information is proposed in this rule. Until the conversion factor is set, no further information regarding physician fees is available.
2010 Medicare Physician Fee Schedule and Claims and Processing
The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 provided a 2.2 percent update to the 2010 Medicare Physician Fee Schedule for dates of services June 1, 2010, through November 30, 2010.
Effective December 1, 2010, physicians face a 23 percent cut to payments for services delivered to Medicare beneficiaries. It is anticipated that additional efforts will be made to prevent this scheduled cut to payments; however, new legislation that provides an update to the Medicare Physician Fee Schedule is not guaranteed.