Proposed Medicare Fee Schedule 2013
Proposed Medicare Fee Schedule for 2013
CMS has published their proposed Medicare Physician Fee Schedule (MPFS) for 2013 and the final schedule will be posted in November 2012. The proposed fee schedule is 765 pages; therefore, please see below for a synopsis of the proposed changes to the 2013 MPFS:
1. Projected 27% Cut to Physician Reimbursement: When combining the continued use of the SGR (sustainable growth rate) formula to calculate the physician schedule and the legislative fixes that have been implemented to prevent previous cuts to the schedule, the MPFS is scheduled for a 27% cut for 2013. In previous years, Congress has intervened to prevent these reductions; however, at this time, no proposed legislation has been introduced.
2. Transition Care: For the first time, CMS is proposing to pay for the care required to help a patient transition back to their community following the discharge from a hospital or nursing facility. CMS is proposing to make a separate payment to a physician’s community physician or practitioner to coordinate their care in the 30-day period following their hospital/nursing facility discharge.
3. E-Prescribing Incentive Program (eRx): CMS has proposed two new hardship exemptions for physicians to avoid the 2013 and 2014 eRx payment penalties:
a. Eligible physicians who achieve EHR meaningful use during the six or 12 month payment adjustment reporting period.
b. Eligible professionals who have registered to participate in the EHR incentive program and adopted certified EHR technology prior to applying the respective payment adjustment.
4. Increasing the number of Medicare-covered preventive services that can be provided through telehealth. CMS proposes to add the following list of services for 2013:
a. G0396: Alcohol and/or substance (other than tobacco) abuse structured assessment and brief intervention, 15 to 30 minutes
b. G0397: Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention greater than 30 minutes
c. G0442: Annual alcohol misuse screening, 15 minutes
d. G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
e. G0444: Annual Depression Screening for adults, 15 minutes
f. G0445: High-intensity behavioral counseling to prevent sexually transmitted infections, face-to-face, individual, includes: education, skills training, and guidance on how to change sexual behavior, performed semiannually, 30 minutes
g. G0446: Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
h. G0447: Face-to-face behavioral counseling for obesity, 15 minutes
5. Implementing a face-to-face requirement between physician and patient as a condition for payment of certain high-cost Medicare DME items (Please see http://www.mwe.com/overview-of-2013-mpfs-proposed-rule-and-dme-written-order-and-face-to-face-encounter-requirements-07-25-2012/ for additional details on this requirement.
6. Application of a multiple procedure payment reduction to the technical component of the second and subsequent cardiovascular and ophthalmology diagnostic services furnished by the same doctor to the same patient on the same day. Under the proposed rule, Under this proposed policy, CMS would make full payment for the highest paid cardiovascular or ophthalmology diagnostic service and reduce the technical component payment for subsequent cardiovascular or ophthalmologic diagnostic services furnished by the same physician or group practice to the same patient on the same day by 25%.
7. When permitted by State law, Medicare will now pay for interventional pain management performed by CRNAs in order to foster access to these services
8. Introduces next phase to enhance the Physician Compare Website (http://www.medicare.gov/find-a-doctor/provider-search.aspx). CMS plans to foster transparency and public reporting of certain information to allow Medicare beneficiaries access to more information when choosing a physician, including the following:
a. CMS proposed to publish performance rates on quality measures that group practices submit through the GPRO web-interface under the 2013 PQRS and Medicare Shared Savings Program.
b. In 2014 or later, CMS proposes to publicly report composite quality measures.
c. CMS proposes to add patient experience survey-based measures as well as publicly report patient experience data for all group practices participating in the 2013 PQRS through the group reporting option and the Medicare Shared Savings Program.