decisionhealth Newsletters, Part B News - 2010 Issue 7 (July)
New billing opportunities; RVU, GPCI changes proposed for 2011
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Article Overview
This article reviews a broad set of proposed 2011 Medicare payment and coverage changes tied to the Medicare Physician Fee Schedule and health reform implementation. It is aimed at physicians, coders, billing staff, compliance teams, and practice managers who need to understand how proposed updates may affect reimbursement, reporting, and service coverage across multiple specialties. The discussion covers preventive care expansion, practice expense and geographic payment adjustments, Medicare quality reporting changes, imaging and therapy payment policies, dialysis-related valuation updates, and other administrative billing changes.
Why This Topic Matters
The proposed changes described here could affect how practices are paid, what services are covered, and how claims and quality reporting are handled. Readers can use the article to gauge whether the 2011 Medicare rulemaking may impact their specialty, workflow, or reimbursement environment.
Article Sections
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Overview of the proposed 2011 Medicare Physician Fee Schedule
Introduces the scope of the proposed rule and its connection to Medicare payment policy and health reform. Summarizes the major categories of changes addressed in the article.
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Preventive medicine and primary care provisions
Covers the new annual wellness visit benefit, expanded preventive service coverage, and proposed payment support for primary care services. Also notes related changes that affect beneficiary cost-sharing and service eligibility.
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Practice expense, imaging, and therapy payment changes
Discusses proposed adjustments to practice expense calculations, multiple procedure payment reductions, and equipment utilization assumptions. Includes broader payment revisions affecting imaging and therapy-related services.
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Code valuation and review initiatives
Summarizes CMS and AMA/RUC review activity related to potentially misvalued services, pricing corrections, and work RVU scrutiny. Addresses the agencies' efforts to reexamine selected service values and payment inputs.
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Geographic payment adjustments and specialty-specific updates
Reviews proposed changes to geographic practice cost indices and related weighting factors, along with specialty-specific updates such as diabetes self-management training, dialysis, pulmonary rehabilitation, and canalith therapy.
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Other billing, disclosure, and reporting changes
Covers additional Medicare policy proposals including surgery incentives in shortage areas, self-referral disclosures, timely filing limits, PQRI updates, and e-prescribing changes. These provisions focus on billing administration, compliance, and reporting participation.
What You Will Learn
- How the proposed Medicare fee schedule changes are organized by payment and coverage category
- Which areas of practice are most affected by the proposed updates
- What kinds of reporting and administrative changes are being proposed for Medicare participants
- How the article frames the relationship between health reform and Medicare billing changes
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice managers
- Compliance professionals
- Non-physician practitioners
Codes Discussed
Code Ranges Discussed
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