The proposed rule would make a number of changes to payments for specific services paid under the MPFS. For example, the proposed rule would adopt the recommendation of the American Medical Association's Relative Value Update Committee (RUC) that would increase the value of the work component of anesthesia services by 32 percent. In addition, it would adopt the recommendations of the RUC with regard to more than 50 procedures which were included in the 2007 five year review of work, but for which a decision was deferred until the 2008 proposed rule.

CMS is proposing to revise the methodology for determining the average sales price (ASP) for Part B drugs by defining bundled arrangements and requiring that drug manufacturers allocate bundled price concessions proportionately to the dollar value of units of each drug sold under the bundled arrangement when reporting ASPs. This proposal will help the ASPs to better reflect the true costs incurred by physicians when purchasing Part B covered drugs. The CMS proposal is in response to MedPAC's January 2007 report to Congress, suggesting that CMS policy on reporting discounts might need to change over time. In addition it is consistent with the proposed Medicaid policy for bundled sales.


CMS is also proposing to continue to pay for preadmission-related services for intravenous infusion of immunoglobulin (IVIG) under a temporary HCPCS code, G0332. This payment is for the extra resources expended in locating and obtaining IVIG products that are appropriate for the patient's treatment, and for scheduling the patient's infusions. This service may be billed for each visit to the physician's office at which IVIG is administered.

Other provisions in the proposed rule include:

-- Updating the Geographic Practice Cost Indices (GPCI) to reflect more recent data.

-- Revising certain physician payment localities according to one of three proposed options

-- Using the Physician Assistance and Quality Initiative Fund (PAQI), created by TRHCA that provides $1.35 billion for physician payment and quality improvement initiatives, to extend voluntary quality reporting bonus payments into 2008.

-- Requiring that persons furnishing physical and occupational therapy services to people with Medicare meet licensing, registration, or certification requirements in the state in which they practice, and that they complete an approved educational program for the services they are furnishing. The proposed rule would also change the time frames for certifying a plan of care.

More Industry Headlines