Society Comments on 2010 MPFS Final Rule

On December 23, 2009 the Heart Rhythm Society issued comments to the Centers for Medicare and Medicaid Services (CMS) in response to the final rule "Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010" as published in the Federal Register on November 25, 2009.
         Read the Society's 12/23 comment letter » (PDF, 380K)

While a number of provisions were adopted in the final rule, the Society’s comments focused on two issues of critical importance to our members — the elimination of the consultation codes and the use of the American Medical Association Physician Practice Information Survey (PPIS) data to calculate practice expense inputs.

Consultation Services

In the final rule, CMS chose to finalize its proposal to eliminate all consultation codes, except for those used in the delivery of telehealth services, citing longstanding confusion due to differences between Medicare guidelines and Current Procedural Terminology (CPT) guidelines.

Under the new policy, effective January 1, 2010, CMS will no longer recognize Evaluation and Management (E/M) consultation codes 99241-99244 for office/outpatient services and 99251-99255 for inpatient hospital services. Rather, CMS has instructed physicians to use E/M codes for new or established office/outpatient services or initial hospital care.

In our comments, we alerted CMS to the adverse affects that elimination of consultation codes will have on the delivery of services and quality of care for Medicare patients and urged the agency to refrain from implementing the provision.

Practice Expense

Also in the final rule, CMS adopted its proposal to utilize data from the PPIS to calculate practice expense per hour (PE/HR) rates for cardiology services.

In our comments on both the proposed and final rulemaking, we strongly urged CMS to continue use of the supplemental survey data submitted by the American College of Cardiology until further evaluation of the PPIS data has been conducted, due to concerns with validity of the survey process and the quality of data collected for cardiology.

We firmly believe that CMS’ decision to enact payment policy changes prior to further analysis and validation of the PPIS data will surely exacerbate access problems, and severely affect the quality of care for Medicare patients.

The Society remains strongly opposed to both policy changes and will continue its legislative and regulatory efforts to overturn CMS’ decision. We will keep you informed of these activities as they develop.