Medicare Payments Face Another 6.1% Cut Under SGR

Janice Simmons, for HealthLeaders Media , June 28, 2010

In addition, the proposed rule calls for implementing other provisions in the new healthcare reform law:


  • Elimination of deductible and coinsurance for most preventive services: Effective Jan. 1, 2011, the Part B deductible and the 20% coinsurance that would otherwise apply to most preventive services would be waived.
  • Incentive payments to primary care practitioners for primary care services: Incentive payments equal to 10% of a primary care practitioner's allowed charges for primary care services would be made under Part B. The law also defines primary care services as limited to new and established patient office or other outpatient visits; nursing facility care visits; and domiciliary, rest home, or home care plan oversight services; and patient home visits.
  • Incentive payments for major surgical procedures in health professional shortage areas: The new healthcare reform act calls for a payment incentive program to improve access to major surgical procedures -- defined as those with a 10 day or 90 day global period under the Medicare physician fee schedule--in Health Professional Shortage Areas between Jan. 1, 2011 and Dec. 31, 2016. To be eligible for the incentive payment, the physician must be enrolled in Medicare as a general surgeon.
  • Permitting physician assistants to order post hospital extended care services: Physician assistants would be authorized to perform the level of care certification that is one of the requirements for coverage under Medicare's skilled nursing facility (SNF) benefit.
  • Physician self referral for certain imaging services: The healthcare reform law amends the in office ancillary services exception to the self referral law as applied to magnetic resonance imaging, computed tomography, and positron emission tomography. CMS is proposing to require that the referring physician provide a patient with a list of 10 alternative suppliers within a 25 mile radius of the physician's office who provide the same imaging services.
  • Misvalued codes under the physician fee schedule: CMS will be periodically reviewing and identifying potentially misvalued codes and make appropriate adjustments to the relative values of the services that may be misvalued. CMS will be looking for additional categories of services that may be misvalued, including codes with low work relative value units (RVUs) commonly billed in multiple units per single encounter and codes with high volume and low work RVUs.

    Comments on the proposed rule are due Aug. 24, with a final rule to be issued by Nov. 1.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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