CMS Releases 2009 Medicare Proposed Rule

The passage of HR 6331-- Medicare Improvements for Patients and Providers Act of 2008 -- changes the recently released proposed rule for the 2009 Medicare Physician Fee Schedule. The proposal had originally contained a 5.4% reduction to the Medicare physician payment update for 2009, however; the legislation replaces the reduction with a 1.1% increase. Once the legislation becomes law, the payment impact for physician specialties for 2009 will need to be recalculated. The payment impact in the agency's July 7 proposed rule reflects the 5.4% reduction. More information is likely to come from CMS regarding the changes resulting from the legislation.

The Centers for Medicare and Medicaid Services (CMS) will continue to monitor patient access to physician services. Acting Administrator Kerry Weems said beneficiaries in most areas are having little to no problems in seeing their physicians. He expects that to continue in 2009.

The proposed rule contains several provisions relating to quality reporting, such as a proposed final set of quality measures, new reporting periods and the use of electronic health records. The Medicare Improvements Act also authorizes an incentive payment for the satisfactory reporting of data on quality measures for services furnished on or after January 1, 2009. Incentive payments for 2009 previously had not been authorized.

CMS also proposes new licensure, quality and performance standards for diagnostic testing performed by physicians and other non-physician practitioners. CMS proposes several requirements including: requiring technical staff on duty with the appropriate credentials to perform tests; limiting a supervising physician to providing general supervision to no more than three Independent Diagnostic Testing Facilities sites; and having a supervising physician to prove proficiency in the performance and interpretation of each type of diagnostic procedure furnished in the office.

Another proposal allows an exception to the prohibition on physician self-referral that would permit remuneration provided by a hospital to physicians on its medical staff under incentive payment or shared savings programs, provided certain conditions are satisfied. CMS also proposes changes to enrollment and billing requirements.

Comments on the proposal are due August 29. For the entire proposed rule click HERE or go to
Carol Monaco (

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