2012 Medicare: Some Closure

On February 22, 2012 the President signed legislation which provides some direction for pathologists and laboratories for the rest of this year and sets some expectations for 2013.

• Heading the list is the delay of the reduction in physician payment levels resulting from the application of the SGR formula.  Payment rates are now frozen at current levels through the remainder of 2012.
• The TC grandfather provision remains an issue and has been extended through June 30, 2012 with the direction that hospitals and laboratories should take this time to prepare for the sunset of the grandfather provision by revising their contractual arrangements.
• Clinical Laboratory payment rates are reduced by 2% in 2013 as a way to provide funding for some of the other changes in payment rates.

The following items were put in place as of January 1, 2012.

• Continued review of geographical cost factors have resulted in adjustment of rates.  These changes are technical in nature and do not affect payment rates significantly.
• 2012 sees the third of a four year phase in adjustments to the practice expense RVUs used to calculate payment rates.
• Additional PQRS case types and measures have been introduced in 2012 along with updates as to the reporting of the cases.
• Changes to the e-prescribing system and the electronic health records initiative are also included in the rule.

Other changes of note:

• Hospital place of service guidelines were issued which require samples taken in hospital settings to be coded as a hospital place of service regardless of the site of the clinical or anatomic pathology services.

APS will continue to monitor these regulations and their impact on our client’s practices.  Additional information will be forwarded as it becomes available.  If you have questions, please feel free to contact your Practice Manager.