On Oct. 30, 2008, the CMS issued a final rule for the Medicare Physician Fee Schedule (MPFS) for CY 2009. The final rule establishes payment rates and policy changes that will go into effect for services furnished by physicians and non-physician practitioners to Medicare beneficiaries on or after Jan.1, 2009. The final rule also details changes to payment rates for end-stage renal disease facilities, and improvements to enrollment and billing rules.

Payment Changes

Highlights of payment changes discussed in the final rule include:

  • Updating the fee schedule conversion factor by 1.1 percent, as required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA);
  • Continuing to work with the American Medical Association Relative Value Update Committee (AMA RUC) and the specialty societies to analyze misvalued codes, and developing alternative approaches for identifying these misvalued codes. In addition, CMS plans to continue its review of services that could be bundled or made subject to a multiple procedure payment reduction; and
  • Adding three new facility types to the list of authorized telehealth originating sites: a hospital- based or CAH-based renal dialysis center (including satellites), a skilled nursing facility (SNF) and a community mental health center (CMHC).

Changes to Enrollment and Billing Rules

Many changes were made to enrollment and billing rules, including:

  • The effective date of billing for physicians and non-physician practitioners is the later of: (1) the date of filing of a Medicare enrollment application that was subsequently approved by a Medicare contractor, or (2) the date an enrolled physician or non-physician practitioner first started furnishing services at a new practice location;
  • A physician or non-physician practitioner is not allowed to bill for services furnished after certain reportable events, such as a felony conviction; and
  • Physicians and non-physician practitioners, and physician and non-physician practitioner organizations, are to notify their Medicare contractor of a change of ownership, final adverse action or change of location within 30 days of the reportable event.

For more information, please see here.