decisionhealth Newsletters, Part B News - 2011 Issue 10 (October)
Physician groups slam proposed imaging cuts, tighter rules on wellness visits
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Article Overview
This piece reviews major concerns raised by the AMA and MGMA about CMS’s proposed 2012 Physician Fee Schedule. It is relevant to physician practices, medical group administrators, and coding/billing professionals tracking Medicare payment policy, imaging reimbursement, electronic reporting programs, and wellness visit requirements. The article covers proposed changes affecting advanced imaging payment methodology, electronic prescribing and quality reporting alignment, annual wellness visit rules, and hospital-owned practice billing under the three-day rule.
Why This Topic Matters
The article helps healthcare billing and compliance teams understand which Medicare payment and reporting proposals may affect practice revenue, workflow, and documentation requirements. It is useful for readers monitoring physician fee schedule changes and the positions professional groups are taking before final rulemaking.
Article Sections
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2012 proposed fee schedule
Overview of the proposed CMS physician fee schedule and the general concerns raised by professional organizations. The section frames the policy areas discussed throughout the article.
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Imaging payment reductions
Discussion of proposed Medicare payment changes affecting advanced imaging services and the reactions of physician organizations. The section focuses on the broader reimbursement impact and policy objections.
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Meaningful use, e-prescribing, and PQRS alignment
Coverage of how electronic health record incentives are proposed to interact with electronic prescribing and quality reporting programs. The section addresses program coordination and reporting alignment.
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E-prescribing and PQRS reporting periods and penalties
Summary of concerns about timing differences between reporting periods and penalty application for federal reporting programs. The section addresses how proposed schedules could affect future payment adjustments.
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Annual wellness visit requirements
Discussion of proposed annual wellness visit expectations and related documentation or service-delivery questions. The section covers provider concerns about how the visit is structured.
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Three-day rule for hospital-run practices
Explanation of the proposed billing change affecting hospital-owned or hospital-operated practices when patients are admitted shortly after a visit. The section addresses the anticipated administrative and reimbursement impact.
What You Will Learn
- What CMS proposed in the 2012 Physician Fee Schedule.
- How physician organizations responded to imaging reimbursement proposals.
- How electronic reporting programs are being aligned in the proposal.
- What issues are raised around annual wellness visit requirements.
- How the proposal could affect hospital-owned practice billing workflows.
Who Should Read This
- Physician practices
- Medical coders
- Billing staff
- Practice administrators
- Compliance teams
- Healthcare revenue cycle professionals
Code Ranges Discussed
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