[Federal Register: November 5, 2002 (Volume 67, Number 214)]
[Rules and Regulations]               
[Page 67318]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr05no02-8]                         

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410 and 414

[CMS-1204-N]
RIN 0938-AL21

 
Medicare Program; Revisions to Payment Policies Under the 
Physician Fee Schedule for Calendar Year 2003, Notice of Delay of Final 
Rule

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice of delay of final rule.

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SUMMARY: This document gives notice of a delay in publication of the 
physician fee schedule for calendar year 2003 due to concerns about 
data used to establish the physician fees and the need to further 
assess the accuracy of the data.

FOR FURTHER INFORMATION CONTACT: Terry Kay (410) 786-4497.

SUPPLEMENTARY INFORMATION: The Medicare physician fee schedule 
specifies payments to physicians for more than 7,000 health care 
services and procedures ranging from routine office visits to complex 
surgical procedures. In calendar year (CY) 2003, Medicare is expected 
to pay approximately $44.7 billion to over 750,000 physicians and other 
practitioners for services paid under the physician fee schedule.
    On June 28, 2002, we published a proposed rule to refine the 
resource-based ST practice expense relative value units (RVUs) and make 
other changes to Medicare Part B payment policy, which affect the 
Medicare physician fee schedule for CY 2003. The policy changes 
proposed concerned: the Medicare Economic Index, pricing of the 
technical component for positron emission tomography (PET) scans, 
Medicare qualifications for clinical nurse specialists, a process to 
add or delete services to the definition of telehealth, definition for 
ZZZ global periods, global period for surface radiation, and an 
endoscopic base for urology codes. We also discuss the refinement of 
anesthesia work values, clinical social worker services, and how drugs 
are accounted for in the sustainable growth rate.
    Under the formula set for in section 1848(b)(1) of the Social 
Security Act, the payment amount for each service paid under the 
physician fee schedule is the product of three factors: (1) A 
nationally uniform RVU for the service; (2) a geographic adjustment 
factor for each physician; and (3) a nationally uniform conversion 
factor (CF) for the service. The CF converts the RVUs into payment 
amounts. For each physician fee schedule service there are three RVUs: 
(1) An RVU for physician work; (2) an RVU for practice expense; and (3) 
an RVU for malpractice expense.
    We are concerned about information and data used in establishing 
RVUs for certain physicians' services that would apply under the 
Medicare physician fee schedule for CY 2003. In reviewing the 
information and data used to establish RVUs (including data and 
information obtained from outside sources) we discovered that the data 
and information were incomplete, and we could not, therefore, make an 
accurate evaluation and establishment of RVUs, which form in part the 
basis of payment under the physician fee schedule. The effects of the 
incomplete data and information that we have identified are of such a 
magnitude to affect significantly the rates paid under the physician 
fee schedule for all physicians, non-physician practitioners, suppliers 
and providers paid physician fee schedule rates. Because changes in 
RVUs are done in a budget-neutral manner, RVU changes have 
redistributive implications for all physicians, non-physician 
practitioners, suppliers, and providers paid physician fee schedule 
rates. Using the data and information as currently constituted without 
refinement would result in inappropriate and uneven payments to 
physicians, non-physician practitioners, suppliers, and providers. 
Because it would be impossible to avoid such uneven payments at this 
point based on the current state of information, it would be 
inappropriate to proceed to publication of a final rule with a 
physician fee schedule for CY 2003 until the subject data and 
information can be re-evaluated and then utilized to assign the proper 
number of units under our relative value system.
    In order to thoroughly assess the accuracy of the data and 
information and to assure that they do not contain further inaccuracies 
that might also have significant implications, an intensive review of 
the data and information will be necessary. Because of the time needed 
for this review, we cannot complete this review and recalculate the 
physician fee schedule rates for CY 2003 before November 1, 2002. Once 
our review has been completed and data and information assessed and 
rates revised, we will publish a final rule. We will announce the 
effective date of the physician fee schedule for CY 2003 in that rule.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: October 31, 2002.
Thomas A. Scully,
Administrator, , Centers for Medicare & Medicaid Services.

    Approved: October 31, 2002.
Tommy G. Thompson,
Secretary.
[FR Doc. 02-28147 Filed 11-1-02; 11:57 am]

BILLING CODE 4120-01-P