CMS posts final MPFS, HOPPS rules for 2011

The U.S. Centers for Medicare and Medicaid Services (CMS) has released its final rules on the 2011 Medicare Physician Fee Schedule (MPFS) and the 2011 Hospital Outpatient Prospective Payment System (HOPPS), according to the American College of Radiology in Reston, VA.

MPFS changes

Under the 2011 MPFS, CMS projects that the conversion factor for the sustainable growth rate (SGR) formula will be a 24.9% decrease, at $25.52 effective January 1 (the 2010 conversion factor currently is $36.87). In June, Congress passed a six-month extension of the SGR fix with a 2.2% increase until November 30. If Congress fails to pass a fix to the SGR again, the conversion factor will be reduced by 23% in December to $28.38, the American College of Radiology (ACR) said.

Also in the 2011 MPFS rule, CMS has finalized its policy to reduce payment of the technical component by 50% for second and subsequent studies billed by a physician or entity for a patient who has CT, MR, or ultrasound studies of noncontiguous body areas and across modalities on the same day.

The agency is also finalizing a change in the equipment utilization rate from 50% to 75% for equipment priced more than $1 million in the practice expense database, as mandated by the Patient Protection and Affordable Care Act (PPACA) and Health Care and Education Reconciliation Act (HCERA) of 2010, a change that is to be effective January 1. This policy will affect CT, CT angiography, MR, and MR angiography procedures, and it will also apply to the three new CT abdomen and pelvis codes: 74176, 74177, and 74178, according to the ACR.

In addition, the rule will mandate a disclosure requirement for the in-office ancillary services exception, which requires physicians to disclose that when they refer a patient for an imaging study at a site where they have an ownership interest, they may financially gain from providing this service.

The official version of the 2011 MPFS will be published in the November 29 Federal Register. There is a 60-day comment period that will end on January 2, 2011, the ACR said.

HOPPS updates

The 2011 conversion factor for hospital outpatient services will be $68.87, which includes a 2.6 market basket increase minus a 0.25 percentage point reduction as required under the Affordable Care Act. For hospitals that do not meet the requirements to report quality measures, their reduced conversion factor will be $67.53, according to the ACR.

The payment rates for myocardial PET will change from the 2010 rate of $1,433 to $1,096 in 2011.

The official version of the regulation will be published in the November 24 Federal Register, the ACR said. There is a 60-day comment period on this rule that will end January 3, 2011.

By Kate Madden Yee
AuntMinnie.com staff writer
November 12, 2010

Related Reading

CMS proposes 2.15% increase in HOPPS, July 14, 2010

CMS pitches 90% use rate in proposed 2010 MPFS rule, July 1, 2009

CMS to raise hospital outpatient payments 3%, July 8, 2008

CMS delays Medicare payments due to SGR impasse, July 1, 2008

Beware, AMIC says: The DRA could be the least of it, June 10, 2008

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