New Medicare fee schedule raises rates, limits reforms

December 30, 2008

Medicare’s outpatient imaging program has issued a New Year’s greeting in the form of rules in the 2009 Physician Fee Schedule that raise professional reimbursement rates, expand the discount for contiguous body part imaging to more applications, and introduce anti-markup rules that are far less harsh than those originally proposed.

Medicare's outpatient imaging program has issued a New Year's greeting in the form of rules in the 2009 Physician Fee Schedule that raise professional reimbursement rates, expand the discount for contiguous body part imaging to more applications, and introduce anti-markup rules that are far less harsh than those originally proposed.

A 1.1% across-the-board professional rate increase kicks in on Jan. 1. The rule reflects provisions in the Medicare Improvements for Patients and Providers Act (MIPPA), passed by Congress in July. That law extended a previously approved 0.5% hike through the end of 2008 and established a 1.1% increase for 2009.

MIPPA granted the raise while setting aside an impending 10.6% rate cut required by Medicare's Sustainable Growth Rate policy. Because Congress has delayed several previously planned SGR cuts, physicians now face the possibility of a 20% rate reduction in January 2010 if legislators do not act again.

More immediately, the Centers for Medicare and Medicaid Services added 10 high-tech imaging procedures to the list of those already qualifying for the contiguous body part discounts. It will now pay 100% of the technical component of the first scan in each assigned category and 75% of the rate for subsequent scans acquired during that imaging session or later the same day.

MIPPA also factored in CMS's decision to delay expanding stringent rules for independent diagnostic testing facilities to all outpatient imaging services, including in-office ancillary services operated by referring physicians. CMS set aside a proposal to force IDTFs to seek equipment accreditation for MR, CT, PET, and nuclear cardiology equipment by the end of 2009 because it conflicted with a MIPPA requirement for accrediting those modalities by 2012.

While resolving that conflict, CMS backpedaling on the IDTF rules means that these facilities and in-office services will continue to be subject to very different standards for staff training and certification. In-office services will remain exempt from the rule requiring IDTFs to use registered radiologic technologists with subspecialty certification for the high-tech scanners they operate. High-tech equipment in an in-office setting need not be supervised by a physician deemed proficient in the interpretation of imaging performed with that technology.

"As I understand it, the supervising physician for an IDTF must be a board-certified radiologist," said Thomas W. Greeson, a partner with the law firm of ReedSmith in Falls Church, VA, and a contributor to Diagnostic Imaging. "A group practice may designate any of its physicians, regardless of qualifications, to the role."

CMS also watered down anti-markup regulations designed to discourage ordering physicians from participating in imaging equipment leasing deals that skirt federal anti-self-referral law. The anti-markup rule prohibits ordering physicians from charging Medicare more for the technical services performed on scanners outside their offices than they paid to rent or lease the equipment. Federal law prohibits them from billing Medicare for the use of equipment that they own offsite.

Under the 2009 rule, claims for the technical component of services are exempted from the anti-markup rule when the physician who supervises the test also performs more than at least 75% of all his or her medical services for the billing physician's practice. Exemption from the anti-markup rule can also be secured by qualifying for the "same building" requirement. This stipulates that equipment is exempted if it's located in the office (or same building) where the billing physician practices.

The anti-markup rules still broadly apply to the professional billing component, however. In these instances, the billing physician is prohibited from charging Medicare more than the radiologist is paid to read the imaging study if the study is interpreted at a remote site.

"Teleradiology will be significantly impacted by this rule," Greeson said. "If the radiologist providing interpretation does not bill Medicare separately, then the reassignment of the right to the ordering physician group will be subject to the anti-markup rule."

New MPFS rules also require high-tech mobile imaging services to register with CMS as IDTFs. This potentially costly requirement means that mobile services must bill Medicare separately from the healthcare facilities where their mobile equipment visits. The rule even applies to a mobile equipment trailer anchored at a specific site.

Until now, mobile services have often billed Medicare through the providers who contract for their services. They have not generally signed on with Medicare as participating providers, much less registered as IDTFs, Greeson said. The resulting confusion may require Medicare to clarify, if not modify, its position.

For more information from the Diagnostic Imaging and SearchMedica archives:

Final rules in 2008 Medicare Physician Fee Schedule disappoint some, elate othersMedicare proposals attack self-referralsTeleradiology's financial forecast shows chance of rain