CY 2013 Medicare Physician Fee Schedule Proposed Rule

Proposed changes to policies and payment rates for services paid under the Medicare Physician Fee Schedule (MPFS) for 2013 were released on July 6. The Centers for Medicare & Medicaid Services (CMS) released the proposed rules and the public is free to comment on the changes throughout a 60-day period that ends September 4, 2012.
In its press release, CMS highlighted the fact that the proposed rules would increase payment to family physicians by 7 percent. This boost is part of the administration’s goal to improve primary doctor care, which they hope will ultimately lower the cost of long term health care.

Among the other proposed changes is a CY 2013 conversion factor of $24.7124, which represents a 27.4 percent decline from CY 2012 unless Congress takes action to avert the cut. Congress has acted to avert these cuts every year since CY 2003. An expansion of the Multiple Procedure Payment Reduction (MPPR) has also been expanded in the proposed rule to include certain aspects of cardiovascular and ophthalmic codes, and also group practices’ advanced imaging procedures furnished to the same patient in the same session. CMS also proposed using a sliding scale based on the Prime rate in order to estimate interest costs as a part of Practice Expense methodology. This is expected to decrease Medicare payments to capital-intensive specialties such as radiology.

A number of other physician programs are also affected. The proposed rule will appear in the July 30, 2012, Federal Register and a final rule with responses to commentary will follow on or about November 1, 2012.

For more information regarding this and related issues, please contact Carey Kalmowitz, Esq., or Adrienne Dresevic, Esq., at (248) 996-8510 or visit the HLP website.