On November 1, 2007, the Centers for Medicare and Medicaid Services ("CMS") posted on its website the 2008 Medicare physician fee schedule ("MPFS") final rule. These regulations will be published in the Federal Register on November 27, 2007, and become effective January 1, 2008. Overall, most physicians generally will encounter an average of 10.1 percent reduction in reimbursement next year. However, most anesthesiologists generally will notice an increase in payments for their work by an average of 32 percent. Likewise, most physicians who make house calls generally will benefit from the increase in their work relative value units ("RVUs").

In addition, revisions were made to the qualifications for therapists and therapist assistants to more accurately reflect current educational credentialing organizations and state licensure and/or certification practices. The proposed rule to apply Part B policies to Part A therapy services was not adopted in the final plan, due in part to expressed concerns regarding the effect on student training programs if the Part B payment rules applied. Some changes to the therapy treatment plan requirements in hospitals and skilled nursing facilities ("SNFs") were adopted and CMS intends to implement other Part B policies through manual revisions. The timing for therapy recertifications will be extended to every 90 days with consistency across practice settings. In the absence of legislative action, the therapy cap for 2008 will be $1810 per beneficiary and there will be no exceptions process.

Furthermore, CMS adopted its proposal to continue to pay for preadmission-related services for intravenous infusion of immunoglobulin ("IVIG"). Such services include locating and obtaining appropriate IVIG products and scheduling the infusions. These services can be billed each time IVIG treatments are administered. Similarly, CMS adopted the following additional provisions it proposed on July 12 with no or little modifications:

The enrollment requirements for Independent Diagnostic Testing Facilities ("IDTFs") have been tightened with revised and new standards.
The methodology for determining reimbursement levels for new clinical laboratory tests has been upgraded.
The Comprehensive Outpatient Rehabilitation Facilities ("CORF") regulations have been updated to reflect MPFS payments.
The Geographic Practice Cost Indices ("GPCIs") have been updated to reflect recent data.
Certain ophthalmologic imaging tests have been added to the list of procedures subject to the hospital outpatient prospective payment system ("HOPPS") cap.
Neurobehavioral status exams have been added to the list of covered telemedicine services.
The payment limiting rule (the anti-markup rule) of the purchased diagnostic test ("PDT") policy has not only been expanded but also extended to purchased interpretations (For additional information, please see Payment Matters: Special Alert at www.ober.com/shared_resources/news/newsletters/payment-matters/2007/paymentmatters-110507-p01.html).

The final rule can be downloaded at www.cms.hhs.gov/center/physician.asp.