Medicare maintains and updates fee schedules for all healthcare related costs including physicians, ambulance services, clinical labs, and durable medical equipment. The Medicare Physician Fee Schedule is updated on an annual basis through the rule-making process. APA routinely provides comments on CMS’s proposals.
Development of Fee Schedule Inputs
In 1992, Medicare began to change the way it paid for physician services. In lieu of paying physicians on the basis of their individual charges, CMS established a standardized fee schedule based on the required resources necessary to provide the services or a resource-based relative value scale (RBRVS). All services are valued relative to one another and it is these values which form the underpinning of the fees that are laid out in the physician fee schedule.
The American Medical Association (AMA) and its CPT Editorial Panel and AMA/Specialty Society Relative Value Scale (RVS) Update Committee (RUC) have paid an important role in this process as it has evolved. The AMA CPT Editorial Panel has established a process where CPT coding proposals are reviewed and if approved referred to the AMA RUC. The AMA RUC is a multi-specialty committee which makes recommendations to CMS on the values for the procedures defined by CPT codes. CMS reviews the RUC's recommendation and makes final determination on the fees, which are published each year as part of the Medicare Physician Fee Schedule. Many private payers use the Medicare fee schedule as the basis for determining their fees for providers. This underscores the importance of the APA's participation in the process.
APA is represented in the CPT and RUC process by members of its Committee on RBRVS, Codes and Reimbursement:
- Gregory Harris, M.D. is the APA's representative on the RUC.
- David Yankura, M.D. is the APA's alternate representative on the RUC.
- Jeremy Musher, M.D. serves as an advisor to the AMA's CPT Advisory Committee, which advises the CPT Editorial Panel. Dr. Musher is also the APA's advisor to the RUC.
- Ron Burd, M.D., serves as APA's alternate advisor to the RUC.
- Sarah Parsons, M.D., serves as APA’s alternate advisor to the CPT Editorial Panel
- Becky Yowell, Deputy Director of Department of Reimbursement Policy and Quality is the staff for CPT and the RUC.