2013 Medicare Physician Fee Schedule Contains Good and Bad News November 7, 2012 Medicare, News, Payment 2013 physician payment rule, Medicare payment cuts, transitional care CPT codes 0 As SFMS reported last week, CMS released the final 2013 physician payment rule, which sets payment rates and related policies for next year. Highlights from the 1,362-page ruling Increase in payments for primary care—7% for family physicians and 3-5% for other primary care providers. New “transitional care” CPT codes to reimburse physicians for coordinating patient care within 30 days following a discharge for a hospital or skilled nursing facility. Phone calls and other related care management activities can be billed for payment. 2-6% cut in Medicare fees for a number of specialties, including cardiology, nuclear medicine, ophthalmology, pathology, physical medicine, and vascular surgery. Rules for value-based payment modifier to take effect in 2013 (using 2013 data) with groups of 100 or more physicians. The value modifier will reward physicians who successfully report on quality measures and spend less than the national average per Medicare patient, and penalize physicians with lower quality and higher costs. Plans to streamline physician reporting programs (e.g., EHR meaningful use, Physician Quality Reporting System, eRx programs). Click here to view the full ruling. Looming Cuts Physicians are still facing across the board Medicare payment cuts of nearly 30 percent, if Congress fails to act by the end of the year. The sustainable growth rate (SGR) is set to cut physician rates by 26.5 percent and the so-called “fiscal cliff” would drop payments another 2 percent under the sequestration agreement. The sequestration cut is part of the part of the $1.2 trillion in cuts required by the Sequestration Transparency Act, part of a deal worked out in Congress to end last year’s debt-ceiling crisis. The SGR and sequestration cuts are both set to go into effect on January 1, 2013. There is unanimous agreement in Congress that cuts of this magnitude would result in serious disruptions in care for the nation’s elderly and disabled populations, and cannot be allowed to occur. SFMS/CMA have been working with Congress to stop the SGR and the sequestration cuts during the lame duck session in December. We are also urging Congress to include a California Medicare locality update in the lame duck Medicare legislation. Comments are closed.
