Highlights of the Medicare Final FFY2010 and Proposed CY2010 Rules

Medicare CY2010 Proposed Rule for the Physicians Fee Schedule Payment Policies

The Medicare CY 2010 Proposed Rule for Payment Policies paid under the Physicians Fee Schedule was put on public display on July 1, 2009. This proposed rule contains two provisions that have potential significant impact to physician payments. The first is new survey data that CMS has incorporated into the PE (practice expense) component of the RVU (relative value unit) calculation for CY2010. This results in significant RVU shifts between certain CPT^® Codes. The AMA administered a new survey in CY2007 and CY2008, the PPIS (Physician Practice Information Survey) with 51 medical specialty and health care professional groups. CMS believes it to be the most comprehensive PE source of data to date.

The second significant provision is the conversion factor amount which is used to convert the RVUs to the Physicians Fee Schedule Payments. The methodology is mandated by Congress and termed the SGR (sustainable growth rate). The proposed CY2010 SGR amount is a decrease of 21.5% from the CY2009 SGR amount. In past years, a similar significant decrease was proposed and it was moderated by Congress. There are provisions in the current proposed Congressional Health Care Reform bills to revise the SGR calculation. The AMA and specialty medical societies may have more information regarding this issue.

The Medicare Final CY 2010 rule will be posted no later than October 31, 2009 and will be effective January 1, 2010.

Medicare FFY2010 Final Rule for the Hospital Inpatient Prospective Payment System (IPPS)

The Medicare FFY 2010 Final Rule for the Hospital Inpatient Prospective Payment System (IPPS) was posted on August 1, 2009. Hospital inpatients are paid on a per admission basis under the MS-DRG methodology. The FFY2010 relative weight calculations were based on the final transition year of a cost-based method from a charge-based method.

The payment rates as published in the FFY 2010 Final Rule were slightly increased over the FFY 2010 Proposed Rule. This increase was in part due to no payment reduction for the documentation and coding adjustment.

This FFY2010 Final Rule provisions will be effective October 1, 2009.

Medicare CY2010 Proposed Rule for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC)

The Medicare CY2010 Proposed Rule for the OPPS resulted in slight increases in most payments and no other significant changes.

The Medicare CY2010 Proposed Rule for the ASC continues the payment methodology transition to a percentage of the OPPS payment amounts.

The Final CY2010 Final OPPS and ASC rules will be posted no later than October 31, 2009 and effective January 1, 2010.


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