Medicare Doc-Fix Offsets Include Reduced Payments for Advanced Imaging

As part of the deal to avert the fiscal cliff that was passed on New Year’s Day, Congress extended the 2012 Physician Fee Schedule (“PFS”) through December 31, 2013, effectively freezing implementation of the Sustainable Growth Rate (“SGR”) formula that would have decreased Medicare physician payments by 26.5%. To pay for the cost of the SGR freeze, estimated at approximately $25.2 billion, Congress included several offsets that will reduce payments to other providers, most notably to Hospitals and for end stage renal disease payments.

In addition, as one of a number of smaller offsets, the bill seeks to save approximately $800 million by increasing the Equipment Utilization Rate (“EUR”) for advanced imaging services from 75% to 90%. This change is designed to account for more efficient use of imaging equipment and will take effect as part of the 2014 PFS on January 1, 2014. CMS has previously defined “advanced imaging” as equipment costing $1 million or more.

For more information regarding this and related issues, please contact Adrienne Dresevic, Esq., or Carey Kalmowitz, Esq. at (248) 996-8510, (212) 734-0128 or visit the HLP website.