On December 23, 2011, President Obama signed into law the Temporary Payroll Tax Cut Continuation Act of 2011 (TPTCCA). Section 301 of the TPTCCA prevents a payment cut for physicians that would have taken effect on January 1, 2012. An update of zero percent is effective for claims with dates of service January 1, 2012, through February 29, 2012.

While the physician fee schedule update will be zero percent, other changes to the relative value units used to calculate the fee schedule rates must be budget neutral.   To make those changes budget neutral, the conversion factor must be adjusted for 2012. The Centers for Medicare and Medicaid Services (CMS) is currently developing the 2012 Medicare Physician Fee Schedule (MPFS) to implement the zero percent update.

Wisconsin Physician Services (WPS), the Medicare Part B claims administration contractor for Michigan, will be holding new, January 2012 claims for up to 10 business days in order to effectively test and implement the new 2012 MPFS. CMS expects these claims to be released into processing no later than January 18, 2012. Claims with dates of service prior to January 1, 2012, are unaffected. Finally, Medicare claims administration contractors will be posting the new rates on their websites no later than January 11, 2012.

While the negative update for the 2012 Medicare Physician Fee Schedule is now scheduled to take effect on March 1, 2012, the Obama Administration remains strongly opposed to letting this cut take effect along with a permanent solution to eliminating the Sustainable Growth Rate’s cut.

The Centers for Medicare & Medicaid Services (CMS) has also recently implemented several important changes for Medicare providers and beneficiaries. For many patients, Medicare costs will go down. Medicare cost-sharing for Part B services will decline in some cases and, for the first time, the Part B deductible will decrease, by $22, to $140. Additionally, health care professionals will be paid more to provide selected services for Medicare beneficiaries.

CMS has increased the payment amount for the initial and annual wellness visit, which has no cost sharing for patients, to account for the introduction of health risk assessment (HRA).

CMS believes it is important to balance the comprehensiveness of the HRA with the potential burden on patients and health professional time constraints. As such, in 2012, CMS will allow for variation in the content of the HRA.