CMS Issues Final Rule on Physician Fees for 2013

On November 1, the Center for Medicare & Medicaid Services released a final rule for 2013 on the payments that Medicare will issue for physicians’ fees. Several items in the rule are notable. First, the rule includes a required 26.5 percent reduction to Medicare payments. At this point, it is unclear whether Congress will accept the reduction in light of increased calls for fiscal restraint or whether it will continue to deny the reduction. Assuming that Congress does reject the reduction, payment to primary care practitioners may increase by anywhere from three to seven percent.

The rule also finalizes several changes made to the Meaningful Use and PQRS incentive programs, and will make a series of additional incentives available over the next several years. In addition, it includes new policies allowing for reimbursement for care coordination services provided for up to 30 days following certain kinds of treatment in a hospital or skilled nursing facility. Finally, certified registered nurse anesthetists will now be included in the group of professionals that may be reimbursed by Medicare, to the extent of any service they may provide under state law. These changes are the primary causes of the projected increase in payment to practitioners; however, this increase is contingent on Congress’s action with regard to the final rule.

© 2012 Parsonage Vandenack Williams LLC

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MGMA Releases Proposed 2010 Medicare Physician Fee Schedule Analysis –

The Centers for Medicare & Medicaid Services (“CMS”) recently released the 2010 Medicare proposed physician fee schedule along with a related press release and fact sheet. The regulation includes provisions that confirm a 21.5 percent reduction in 2010 Medicare physician payments unless Congress enacts legislation to reverse this cut.  The regulation also proposes to “remove physician-administered drugs from the definition of “physician services” for purposes of computing the physician update formula in anticipation of enactment of legislation to provide fundamental reforms to Medicare physician payments,” a move that has been advocated by the Medical Group Management Association (“MGMA”) for a long time.

MGMA analyzed the regulation’s impact on medical group practices and is making its analysis available only to members at The proposed fee schedule includes provisions that would affect physician practices as follows:

  • Start implementation of the congressionally-mandated requirement that suppliers of advanced diagnostic imaging services become accredited
  • Notably change the practice expense relative value units for many covered services
  • Increase the equipment usage assumption for equipment costing greater than $1 million
  • Transfer responsibility from the patient to the Medicare program for co-payments for covered outpatient mental health services
  • Add a group practice reporting option to both the Physician Quality Reporting Initiative and the E-Prescribing Incentive Program

 The member-only analysis can be accessed here:

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