HealthDay News -- Medicare participating physicians will get a 1.1 percent across-the-board fee increase in 2009, with the Centers for Medicare & Medicaid Services (CMS) projecting that internists' payments will increase another 1 percent because of changes in the agency's methodology for determining payments. Further, physicians may earn additional incentive payments in 2009. CMS announced all of these changes in its 2009 Medicare fee schedule final rule.

In all, an internist could receive a pay hike of up to 6.1 percent next year.

The rate hike implements a provision of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted July 15. MIPPA averted a 5.4 percent cut that would have taken place under the existing physician fee schedule.

"In terms of the Medicare fee schedule, I think that many physicians -- particularly primary care physicians -- would feel as though if it had not passed, they would have to turn away Medicare patients," said Dr. Eileen Moser, an ACP Northern Governor and president of the New Jersey Chapter. "So, I think this was met with great relief on the part of physicians."

The final rule, made public October 30, describes new and existing opportunities to sweeten Medicare payments.

Beginning January 1, physicians who use electronic prescribing (e-prescribing) to transmit prescriptions to pharmacies may earn an incentive equal to 2 percent of their total Medicare allowed charges during 2009. Congress authorized the E-Prescribing Incentive Program as part of MIPPA.

"E-prescribing can greatly reduce the number of medication errors that jeopardizes the health and safety of Medicare patients and waste precious health care dollars treating conditions that never should have happened," CMS acting administrator Kerry Weems said in a prepared statement.

In addition, physicians who participate in the Physician Quality Reporting Initiative (PQRI) and successfully report quality measures may earn a 2 percent incentive payment. The bonus amount represents a one-half percentage-point increase from 2008.

The final rule also shores up existing regulations that prevent physicians from "marking up" certain diagnostic tests to make a profit. For example, a billing physician could not mark up the charge for an X-ray that is performed or read by an off-site radiologist who works part-time for the practice.

The final rule creates two exceptions to the "anti-markup" payment limit. The markup ban does not apply if, for instance, the offsite professional performs "substantially all" -- meaning 75 percent -- of his or her professional services for the billing physician. The second exception applies in cases where the service is performed in the same building as the billing physician.

"The upshot is that they think they've made it more flexible , but at the same time I think they're trying to protect the Medicare program from arrangements they believe may be abusive or create overutilization," said Michael G. Apolskis, a Chicago attorney whose practice specializes in health law.

The final rule, which consists of nearly 1,500 pages of test -- also:

• Defers a proposal to require physicians who provide diagnostic testing services, other than mammography, to enroll as a Medicare "independent diagnostic testing facility" (IDTF).
• Requires mobile diagnostic testing services to enroll in Medicare as an IDTF and, when providing services to a physician practice, the mobile units must bill Medicare directly.
• Waives the deductible that Part B Medicare beneficiaries pay for their "initial preventive physical examination" under the program and expands the time period under which patients are eligible for the service from the first six months of their Part B enrollment to the first 12 months.. It also expands the benefit to include a discussion of end-of-life planning and measurement of a beneficiary's body mass index. It removes electrocardiogram from the list of mandated services that must be provided.
• Re-opens the public comment period on a proposed new exception to the physician self-referral law for "incentive payments" and "shared savings programs."