There are a number of changes in Medicare reimbursement rates for the year beginning January 1, 2007, many of which represent the first installment of rate adjustments scheduled to be phased in fully over a four-year period. In addition, many procedures have been assigned new Current Procedural Terminology (CPT) Codes by the American Medical Association.
The factors that drove Medicare reimbursement adjustments for 2007 and beyond are outlined below:
- Changes in
the method used
to calculate practice
expenses under
the Medicare Physicians
Fee Schedule (MPFS)
had the most significant
impact on women's imaging procedures. This provision of the MPFS for 2007 resulted in significant decreases in DXA, CAD, and stereotactic guidance for breast biopsies, as well as minimal increases in diagnostic mammography. These rate adjustments will be phased in over a four-year period, so the impact for 2007 is minimized.
- Changes in Relative Value Units (RVU) for professional fees paid under the MPFS produced minimal impact on overall reimbursement rates, but, when combined with the first factor, contributed to the total decreased reimbursement for some procedures, most notably DXA exams.
- The Deficit Reduction Act of 2005, signed into law in February 2006, has received tremendous attention by numerous professional groups and organizations. One of the provisions of this Act is to cap the amount paid for the technical component of an imaging procedure performed in a physician's office or free-standing imaging center to the lesser of the amount paid under the Hospital Outpatient Prospective Payment Schedule (HOPPS) or the MPFS. This Act has no impact on screening and diagnostic mammography, as all payments are made under the MPFS regardless of the place of service; however, it does have an impact on breast biopsy procedures performed in an ambulatory surgical facility. Numerous attempts were made to enact a law to delay implementation of this Act; however, the 2006 Congressional session adjourned without acting on the proposed legislation, which will carry over to the 2007 session.
When the final rule, as it currently stands, is fully implemented in 2010, total reimbursement for DXA will be decreased by 68%, CAD by 48%, and stereotactic guidance by 61%. These decreases in reimbursement could be very troubling for the long-term success of screening programs in breast cancer and osteoporosis and may have the unintended effect of increasing the number of open surgical biopsies performed each year. For these reasons, Hologic and other major medical organizations began a very active lobbying program earlier this year and have generated a significant amount of awareness of the issues among key legislators.
Our efforts to date have gained a strong show of support from numerous elected officials who are or will be positioned to have a positive effect on rolling back these decreases and creating a framework strongly supportive of critical screening programs. We will continue these efforts into 2007 and beyond.
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