7-16-07
CMS Proposes Medicare Physician Fee Schedule Payment
The Centers for Medicare and Medicaid Services (CMS) released for advanced viewing the proposed rule governing payment for physician services and other health care professional services, including outpatient occupational therapy, on July 2. The proposed rule was officially published in the Federal Register on July 12.
Under the proposed fee schedule, Medicare physician payments would decline by 9.9% in 2008. The proposed rule would reduce expenditures by $5.9 billion from calendar year 2007, while providing $58.9 billion to 900,000 physicians and other health care professionals.
AOTA is currently working to review and analyze the rule, which is more than 900 pages long. AOTA will post a summary of the proposed Medicare Physician Fee Schedule (MPFS) on the Web site shortly. In addition, AOTA will be preparing comments to meet the August 31, 2007 deadline. The proposed rule contains several provisions that affect occupational therapy including:
Revised Therapy Standards and Requirements: Requires that persons furnishing physical and occupational therapy services to people with Medicare meet licensing, registration, or certification requirements in the state in which they practice, and that they complete an approved educational program for the services they are furnishing. The proposed rule would also change the time frames for certifying a plan of care.
Comprehensive Outpatient Rehabilitation Facilities (CORF) Services: Updates regulations governing payment of certain services furnished in CORFs, to reflect payment under the MPFS.
Physician Quality Reporting Initiative (PQRI): Outlines measures from seven categories for inclusion in the 2008 PQRI. The proposed rule would also retain the 2007 PQRI measures to the extent that they have been endorsed by the National Quality Forum (NQF).
Outpatient Therapy Cap: Implements the cap on therapy services (except for therapy services furnished in outpatient hospital settings) and would apply the cap exceptions process in 2008, in the absence of congressional action.
Physician Self-Referral Prohibition (STARK Law): Modifies a number of physician self-referral provisions to curb Medicare fraud and abuse, including changes to the in-office ancillary exception for therapy services.
CMS will accept comments on the proposed rule until August 31, 2007, and a final rule will be published in the fall. If you wish your comments to be reviewed and included in AOTA's official Medicare Physician Fee Schedule comment letter to CMS, please e-mail your comments to rrpd@aota.org. The final rule will be effective for services on or after January 1, 2008.
For more information, see the CMS Physician and Health Provider Center.
