Imaging Use Assumption Increase Crops Up In Physician Fee Proposal
This article was originally published in The Gray Sheet
Executive Summary
Whether or not Congress fulfills promises to enact medical imaging physician payment cuts next year, CMS said July 1 that it plans to do just that through its own administrative means
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CMS spares radiation payments, delays imaging cuts
The utilization rate assumption used to calculate Medicare payments for scans with advanced diagnostic imaging equipment selling for more than $1 million will increase from 50% to 90% under CMS' 2010 final physician fee schedule, issued Oct. 30. The change, which will significantly reduce per-scan physician payments, will be phased in over a period of four years rather than being imposed all at once in January 2010, as originally proposed 1("The Gray Sheet" July 6, 2009). Radiation oncology equipment was spared in the ruling, with CMS saying it will not apply the change to expensive therapeutic equipment, as it would have in the July 1 proposed fee schedule. But Medicare imaging physician payment policy may ultimately be determined by Congress. Pending health care reform bills in the House and Senate would mandate increased imaging utilization rate assumptions, but not by as high as 90% (2"The Gray Sheet" Sept. 21, 2009)
CMS spares radiation payments, delays imaging cuts
The utilization rate assumption used to calculate Medicare payments for scans with advanced diagnostic imaging equipment selling for more than $1 million will increase from 50% to 90% under CMS' 2010 final physician fee schedule, issued Oct. 30. The change, which will significantly reduce per-scan physician payments, will be phased in over a period of four years rather than being imposed all at once in January 2010, as originally proposed 1("The Gray Sheet" July 6, 2009). Radiation oncology equipment was spared in the ruling, with CMS saying it will not apply the change to expensive therapeutic equipment, as it would have in the July 1 proposed fee schedule. But Medicare imaging physician payment policy may ultimately be determined by Congress. Pending health care reform bills in the House and Senate would mandate increased imaging utilization rate assumptions, but not by as high as 90% (2"The Gray Sheet" Sept. 21, 2009)
Senators oppose radiation cuts
Sens. Blanche Lincoln., D-Ark., and Richard Burr, R-N.C., lead a bipartisan group of 32 senators on a letter to Health and Human Services Sept. 23 opposing proposed cuts to radiation oncology services in CMS' draft 2010 physician fee schedule. The proposal would change the assumed Medicare utilization rate from 50% to 90% for equipment valued at more than $1 million per unit, effectively reducing the per-scan payment for services including magnetic resonance imaging and cancer radiation treatments. The bipartisan letter points out that the use rate change is based on a Medicare Payment Advisory Commission recommendation targeting diagnostic imaging, not radiation oncology, which is hit with a 19% cut in the proposal (1"The Gray Sheet" July 6, 2009)