CMS releases final 2013 fee schedule: Physicians to coordinate care

Primary care physicians will get a 7% pay increase and other providers will see bumps between 3% and 5% in 2013, according to the final 2013 Medicare physician fee schedule released late Thursday.

A 26.5% sustainable growth rate (SGR) cut would offset those increases on Jan. 1 but likely will be delayed again, CMS said in a statement.

Among the major changes from the proposed fee schedule released in July is the value-based payment modifier will apply to groups with 100 or more eligible professionals in 2015, compared with 25 or more providers in the proposed rule.

Here are some topics covered in the final fee schedule:

  • New code for post-discharge transitional care management, which will contribute to the family practitioner payment boost by allowing doctors to bill for the coordination of patients’ care in the 30 days following a hospital discharge. The new code will be paid for by cuts to other specialties’ payments.
  • Revisions to the value-based payment modifier. This major piece of the Affordable Care Act, which will apply eventually to all practices, will award bonuses or levy penalties depending on how your quality and cost of care compares with that of other physicians. If you have fewer than 100 eligible professionals, the modifier does not apply to you until at least 2017.
  • Broader privileges for non-physician practitioners. Certified registered nurse anesthetists (CRNAs) will be able to perform and report any service permitted by state scopes of practice. In addition, all NPPs, dentists and podiatrists will be able to order mobile X-rays next year.
  • Alignment of incentive programs. Changes to the physician quality reporting system (PQRS) and e-prescribing programs and updates to the Medicare electronic health records (EHR) incentive pilot program will streamline reporting.
  • DME face-to-face requirement. Providers are required to documents a face-to-face encounter when prescribing durable medical equipment (DME) to get paid.

Expect complete coverage, including payment and coding analysis and detailed discussions of new policies and programs, in the Nov. 12 issue of Part B News.

From the Decision Health Article