On June 30, 2008, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2009 Medicare Physician Fee Schedule (MFS). A final rule should be issued November 1, 2008 and the revised policies and payment rates become effective January 1, 2009. The proposed rules cover a wide range of topics affecting physician compensation and the manner in which physicians provide and are paid for services. Some highlights include: changes to the Independent Diagnostic Testing Facility (IDTF) enrollment requirements; clarification and proposed changes to the Purchased Diagnostic Testing or Anti-markup Rules; a new Stark exemption for incentive payment and shared saving programs (gainsharing); and proposed revisions to the Physician and Non-Physician Practitioner Enrollment Requirements. In comment letters to CMS (which were due by August 29th), physician groups and the American Medical Association (AMA) all overwhelmingly supported the gainsharing exemption; although, Congressman Stark, who authored the laws, believes the exemption is ill-advised. Physician groups strongly opposed the limits on billing for diagnostic tests performed in their offices.