By now, physicians and their practices are familiar with the medicare acronyms HIPAA (Health Insurance Portability and Accountability Act) and NPI (National Provider Identifier). The newest Medicare acronym is MIPPA (Medicare Improvement for Patients and Providers Act). This month's column contains information about the effect of MIPPA on reimbursement.
What is MIPPA? On July 15, 2008, the Medicare Improvements for Patients and Providers Act of 2008 was enacted, making significant changes to the Medicare program.
One important and immediate action of MIPPA for physician practices was that the planned midyear 2008 Medicare Physician Fee Schedule (MPFS) rate reduction of -10.6 percent was replaced with a 0.5% update, retroactive to July 1, 2008. While this new fee schedule was being implemented, claims were put on a "rolling hold". Once the new schedule was in place, all claims were reprocessed and paid at the higher rate and all previously held claims were to have been paid by mid-August.
Under MIPPA, the Physicians Quality Reporting Initiative (PQRI) program has been extended through 2010 and physicians will see an increased incentive bonus payment of 2%. This additional incentive is
intended to encourage more physicians to participate in this voluntary (for now) program.
MIPPA also has a number of provisions for electronic prescribing. Section 132 of MIPPA authorizes the Secretary for Health and Human Services to provide incentive payments from 2009 through 2013 to physicians who are successful with electronic prescribing. The success of physicians using electronic prescribing will be measured by reporting the applicable electronic prescribing measures under PQRI. Beginning in 2012, eligible physicians who are not successful electronic prescribers will receive a reduction in payment.
Other MIPPA changes that may be of interest to physicians include increased fee schedules for some mental health services, reinstatement of the therapy caps exceptions process, and delayed the DME Competitive Bidding Program which was originally scheduled to begin July 1, 2008. There are also improvements to the coverage of Medicare preventive services. For example, as of January 1, 2009, the deductible for the "Welcome to Medicare" physical will be waived.
More information on MIPPA and physician reimbursement issues may be found on the CMS website, http://www.cms.hhs. gov/PhysicianFeeSched/.
Barbara J. Good
WVSMA Physician Practice Advocate