Final Rules Include 10% Primary Care Incentive Pay, Reimbursement Cuts

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Primary-care doctors would receive a new 10% incentive under the Centers for Medicare & Medicaid Services final 2011 physician fee schedule, while reimbursements for certain tests and procedures will be slashed by as much as 50%.

While reimbursements continue to be scaled back for a growing number of procedures and services, payments for certain primary care services and surgical procedures would increase under Centers for Medicare & Medicaid Services final 2011 physician fee schedule. The final rules were published Monday in the Federal Register.

Under the final rules, the 2011 fee schedule expands patient access to annual wellness visits, beginning Jan. 1. The new provisions would also cover some preventative services, including screenings for breast and colon cancer, for Medicare beneficiaries that will no longer require patient co-pays.

The new fee schedule now includes a new 10% incentive payment for most primary-care providers and general surgeons who practice in regions with doctor shortages, or “Health Professional Shortage Areas,” under the Patient Protection and Affordable Care Act.

Another provision will slash reimbursements for multiple services that are performed in the same day. For example, if a patient has an ultrasound and MRI in the same day, payment for the second service (and any subsequent services) will be cut by 50%.

The new rules continue to call for Medicare reimbursement cut of up to 25% by the beginning of the year (a 23% cut that is scheduled to go into effect on Dec. 1 and an additional 2% cut on Jan. 1, 2011). Earlier this month, the Senate voted to keep reimbursements at current rates through Dec. 31. The House has yet to vote on the measure.

Physicians groups, including the American Medical Association and the American Academy of Family Physicians, have called for lawmakers to implement a permanent fix to the sustainable growth rate, the formula used to calculate Medicare reimbursements.

Monthly premiums for Medicare participants will increase to $115.40 for the fee-for-service Part B plan next year, while Part A premiums will decline by $11 a month to $450, according to the CMS.

Though the final rules were published this week, the CMS will continue to accept comments on portions of the rule until Jan. 3, 2011.