Medicare Physician Fee Schedule – CY 2013 Proposed Rule

On July 6, 2012, CMS issued the CY 2013 Medicare physician fee schedule proposed rule.  The rule includes several key aspects discussed below, such as improvements in payment for primary care and cuts to payments for specialty care. 

Improving Payment for Primary Care.  The proposed rule includes a number of initiatives designed to increase payments for primary care. Payments for primary care would increase for a variety of reasons, including a proposed new payment for managing a beneficiary’s care when the beneficiary is discharged from certain health care facilities, such as a hospital, skilled nursing facility, inpatient rehabilitation facility, and other similar types of facilities. This would be achieved by creating a new procedure code for providing “post-discharge transitional care management services”, which would apply to all services related to transitional care management within 30 days following the date of discharge from an eligible facility.

Payments to primary care specialties are also impacted by the completion of the transition to new practice expense RVUs using data obtained from the new Physician Practice Information Survey. Overall, CMS would increase payments to family physicians by approximately 7%, with a 3%-5% increase for other primary care physicians.

Cuts to Payments for Specialty Services. Due to the budget neutral nature of the reimbursement system, increasing payment for primary care will necessarily result in decreasing payment for other services. Specialties and/or services that would receive payment reductions include anesthesiology (3%), cardiology (3%), radiation oncology (14%), radiology (4%), and diagnostic testing facilities (8%), among others.

CMS will accept comments on the proposed rule through September 4, 2012, and is expected to issue a final rule on or about November 1, 2012.

If you are interested in commenting on the proposed rule and would like assistance developing those comments or if you need additional information on the proposed rule, please contact a member of Benesch’s Health Care Practice Group.

You can find a copy of the CY 2013 Medicare physician fee schedule proposed rule here —>  CY 2013 Physician Fee Schedule Proposed Rule

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