Helpful information from the American Health Lawyers Association 

President Obama Signs Into Law a Temporary Fix
to Physicians' Medicare Reimbursement
By Jeffrey Moore**

On December 19, 2009, President Barack Obama signed the Department of Defense Appropriations Act, 2010 (H.R. 3326), into law, which freezes Medicare physician payments for two months, avoiding a 21% payment cut to physicians' Medicare reimbursement scheduled to go into effect
on January 1, 2010. The House previously approved H.R. 3326 on December 16, 2009, while the United States Senate passed H.R. 3326 on December 19, 2009.

Because the Department of Defense Appropriations Act, 2010, is only a temporary fix to the Medicare physician payment issue, Congress will be forced to address this payment issue in early 2010, as the Medicare physician payment cuts are set to go back into effect on March 1, 2010.

**We would like to thank Jeffrey S. Moore, Esquire (Phelps Dunbar LLP, Tupelo, MS), for providing this email alert, and the Regulation, Accreditation, and Payment Practice Group for sharing this email alert with the Physician Organizations Practice Group.

Thanks to the American Bar Association’s Physician Interest Group for the following summary of the “final” Medicare Fee Schedule issued today.   

Unless Congress acts, the 21.2% statutorily mandated reduction of overall physician fees will be implemented effective January 1, 2010.  The “final” regulation contains the following provisions of particular interest to physicians:

 *          Eliminates the use of all consultation codes (inpatient andoffice/outpatient codes for various places of service except for telehealth consultation G-codes) on a budget neutral basis by increasing the work relative value units (RVUs) for new and established office visits, increasing the work RVUs for initial hospital and initial nursing facility visits, and incorporating the increased use of these visits into practice expense (PE) and malpractice RVU calculations.

*          Finalizes the proposal to remove physician-administered drugs from the definition of "physician services" for purposes of computing the physician update formula.  This long-awaited administrative step mitigates the size of future Medicare Part B reductions.

*          Phases in new PE RVUs over four years using revised survey data that will result in significant increases and decreases to the PE values of many codes.

*          Establishes a Physician Quality Reporting Initiative (PQRI) reporting mechanism via qualified electronic health records.

*          Defines the size of a group practice as at least 200 providers for purposes of the new PQRI group-practice reporting option.

 *          Increases the utilization assumption for diagnostic equipment priced at more than $1 million, which will decrease the technical component payment for services performed on this equipment.  This change will be phased in over 4 years.