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January 25, 2018

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Medical Coding News Archives

Final Rule Cuts Medicare Physician Payment by Nearly a Third

November 12, 2010:

Providers can expect a reduction in Medicare payment of more than 30 percent in 2011 unless Congress grants a reprieve. In the Medicare physician fee schedule (MPFS) final rule that the Centers for Medicare and Medicaid Services has placed on display, providers paid under the MPFS are looking at a 2011 conversion factor of $25.5217, effective January 1, 2011. The current conversion factor is $36.8729.

The reduction is the result of adjustments that must be made under the sustainable growth rate (SGR) formula. Providers should also keep in mind that the current conversion factor is slated to revert to the 2010 SGR level of $28.3868 (a 24.9 percent reduction) for the December 1 through December 31 period.

Other policies within the rule that could affect physician payment include:

  • Elimination of the deductible and coinsurance for most preventive services
  • Coverage of an “annual wellness visit including a personalized prevention plan”
  • Incentive payments for:
    • primary care services
    • major surgical procedures provided in a health professional shortage area (HPSA)
  • Revisions to the practice expense portion of the geographic practice cost indexes (GPCIs)
  • Multiple procedure payment reductions specific to physical therapy services

The final rule is due to be published in the Federal Register on November 29. Until that time, it can viewed at: www.federalregister.gov/inspection.aspx#special.


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