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Major Changes to the 2013 Medicare Physician Fee Schedule

Posted 8:21 PM by

Big changes could be coming to Medicare reimbursement methodology and rates for 2013 according to the latest fee schedule released by the Centers for Medicare & Medicaid Services (CMS). While many of the changes appear to have slightly negative effects on reimbursements, the overall plan aims to incentivize the coordination of care among providers and ensure participation in quality of care reporting.

The most eye-catching aspect of the proposed fee schedule is the 14% pay cut to specialists in radiation oncology. Additionally, radiologists will see their reimbursement continue to decline by 4% this year. The winners of the proposed schedule are family medicine and internal medicine physicians, who are expected to see reimbursement increases of 7% and 5%, respectively. The elephant in the room, however, is the possibility of a 27% reduction in MPFS payment rates under the SGR methodology due to the expiration of the adjustment made for 2012. If Congress fails to extend the statute that has so far delayed the cuts, there will be a tremendous drop in reimbursement rates across all specialties.

To encourage providers to coordinate care, CMS has proposed reimbursing practices roughly $95 per encounter to follow-up with a recently discharged patient. This move looks to integrate hospital care with outpatient services in order to improve the patient’s transition back to normal life. In conjunction with the coordinated care measures, CMS is seeking to improve the reporting of quality measurements by slashing reimbursements by 1% to 1.5% for practices that do not adequately participate in quality of care programs such as the Physician Quality Reporting System (PQRS) or the Electronic Health Records (EHR) Incentive Pilot Program.

Together these rules attempt to continue the implementation of the physician value-based payment modifier (value modifier) and move providers towards to the ACO program contained within the Affordable Care Act (ACA).

To view a complete copy of the proposed 2013 fee schedule click here.

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Katz, Sapper & Miller’s Healthcare Resources Group serves healthcare providers, including physicians, hospitals and health systems, surgery centers, and long-term care facilities. Our team of healthcare professionals has the scope and depth to meet client needs. Learn more.

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