CMS Proposes New Payment Rates for Physicians

CMS projects that it will pay an estimated $61.5 billion to 875,000 physicians and other healthcare providers in 2007, under a proposed rule that would revise payment rates and policies under the Medicare Physician Fee Schedule.

"Medicare's coverage of preventive care is better than ever, and we are taking another step in 2007," Mark B. McClellan, MD, PhD, CMS administrator said. "We're also going to provide better support for physicians to spend time with their patients, and greater accuracy in payments for some services."

Under the proposed rule, preventive service will continue to expand. For example, the rule would eliminate provisions in the Deficit Reduction Act (DRA) of 2005 and would allow for abdominal aortic aneurysm (AAA) screening to be added to the list of preventive services covered. The screening benefit will include a 1-time-only ultrasound screening for individuals who take advantage of the Initial Preventive Physical Examination benefit, as well as appropriate education, counseling, and referral services. The screening benefit is limited to patients who are at risk for AAA, including anyone with a family history of AAA; men aged 76 to 70 years who have smoked ≥100 cigarettes in their lifetime; and any other patient who manifests risk factors that are strongly recommended for screening by the US Preventive Services Task Force.

The proposed rule would implement a provision in the DRA that provides a Part B deductible waiver for colorectal cancer screening. It would also expand the number of those who qualify for bone mass measurement because of long-term steroid therapy; the rule would reduce the dosage equivalent required for coverage eligibility by one third, from an average of 7.5 mg/day of prednisone (eg, Meticorten, Deltasone) for at least 3 months and up to 5.0 mg for at least 3 months.