2013 Medicare Physician Fee Schedule Released
In mid-November, CMS issued the final 2013 Medicare Physician Fee Schedule rule with a comment period closing Dec. 31; the rule will take effect on Jan. 1, 2013.
The AMA issued a statement applauding CMS inclusion of some of the AMA’s key recommendations in the final rule and the rule’s provision of an appeals process and two additional penalty exemptions for physicians participating in the Medicare e-prescribing (meaningful use) program.
A CMS fact sheet on the rule is available at www.cms.gov/apps/media/press/release.asp?Counter=4469. Oregon-specific information from Noridian is available at www.noridianmedicare.com/partb/fees (please note: those using the Google Chrome internet browser may have difficulty viewing the Noridian website and may need to use another browser to view this page).
Deep Medicare cuts scheduled for Jan. 1 unless Congress acts
The AMA statement also called on Congress to take action to prevent the 26.5 percent cut in Medicare physician payments scheduled for Jan. 1, 2013 due to the flawed Sustainable Growth Rate formula. AMA President-Elect Ardis D. Hoven, MD, stated that “eliminating this failed formula will allow us to enter a period when physicians can begin transitioning to new payment and delivery models to help meet the overall goal of improving patient care and moving to a higher performing Medicare program."
Members of Congress are back in Washington, D.C., for a lame duck session in which they’ll need to make some important decisions regarding the so-called “fiscal cliff” that threatens a number of drastic tax and spending policy changes. In addition to the 26.5 percent Medicare SGR cuts, across-the-board “sequestration” cuts to defense spending and domestic programs, including Medicare, are scheduled for 2013, along with various tax provisions and expiring tax cuts. Lawmakers must work together to resolve these important issues and avoid going over the fiscal cliff. If no action is taken, these deep cuts to Medicare will threaten beneficiaries’ access to care.
Check the AMA’s Patients’ Action Network website frequently at www.patientsactionnetwork.org for the latest developments and opportunities to take action. You can stay in touch with the offices of your U.S. Representative and Senators through the AMA Grassroots Hotline at (888) 434-6200. Remind them that the devastating Medicare cuts must be prevented at all costs before it’s too late.
Medicare Open Enrollment Time is Here
Know your options and update your Medicare participation status by Dec. 31
Physicians can review and modify their Medicare participation status through Dec. 31, 2012. Whether or not you are thinking about modifying your Medicare status, the OMA and AMA encourage physicians to prepare for this opportunity and review participation options carefully to determine the direction that is right for your practice. The AMA has developed the Know your options: Medicare participation guide, available to all physicians at www.ama-assn.org/go/medicareoptions. The kit contains a detailed explanation of participation options, a revenue calculator and various sample materials for communicating with patients.
Review your participation options now and make any necessary modifications by Dec. 31. As the Medicare participation deadline approaches, the OMA encourages our members to continue caring for patients who are aging into Medicare eligibility.
New ABN Form
- As of November 1, 2011, CMS requires physicians and other providers to use the revised version of the ABN (Form CMS-R-131), which was released on May 16, 2011.
Click here to access the new form go to the website below, scroll down to Downloads and click on the Revised ABN CMS-R-131 Form and Instructions zipped document.
- Medicare Program Overview
- Oregon's Medicare Part B Carrier-Noridian Administrative Services
- 2011 Medicare Physician Fee Schedule
- Medicare Part B Enrollment Information
- Medicare Private Contract and Opt Out Affidavit
- Medicare Reimbursement Resources
- Medicare News
- Medicare Frequently Asked Questions
- Medicare Fraud and Abuse
- Medicare Legislative Advocacy
- Physician Quality Reporting System (PQRS, Formerly PQRI)
From the Centers for Medicare and Medicaid
Medicare is a health insurance program for:
- people age 65 or older,
- people under age 65 with certain disabilities, and
- people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services.
Medicare deductible and premium rates may change every year in January.
Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
Noridian Administrative Services is the Medicare Part B carrier for Oregon. Their website, https://www.noridianmedicare.com/p-medb/, is very useful for obtaining the latest news regarding Medicare Part B as well as obtaining any necessary Medicare forms needed for your practice.
The 2011 Medicare Physician Fee Schedule can be accessed through the Noridian website. Noridian is the Medicare Part B carrier for Oregon: www.noridianmedicare.com/p-medb/fees/index.html.
Noridian Administrative Services has a comprehensive website on Medicare Part B Enrollment information, which includes necessary forms and educational resources at https://www.noridianmedicare.com/p-medb/enroll/.
The Sustainable Growth Rate (SGR) is a component of the CMS formula used to calculate physician payments for providing services to Medicare patients. It is based on the GDP and not on actual healthcare practice costs.
- The SGR will lead to steep cuts in physician compensation for services to Medicare patients. The SGR is a target expenditure growth number. If actual expenditures exceed the SGR, physicians’ payments are cuts.
For more information on how the flawed formula is affecting physician Medicare payments, please visit http://www.ama-assn.org/ama1/pub/upload/mm/399/nac_ppfacts.pdf.
Medicare Payment Cut Reversed, Rates Extended through May
On the evening of April 15, President Obama signed into law HR 4851, the Continuing Extension Act of 2010, thereby reversing the 21.3 percent Medicare physician payment cut that went into effect on April 1. This fix extends 2009 Medicare payment rates through the end of May and retroactively applies the 2009 rates to all physician services provided to Medicare patients in April. The law also extends other expiring programs, including COBRA and unemployment benefits to those who have lost their jobs.
After drawn-out deliberations in the Senate, an amended version of the legislation finally passed by a vote of 59-38, and shortly after 8:00 pm on April 15, it passed the House by a vote of 289-112.
As reported previously in PRN, CMS ordered its carriers to hold all claims for services provided in April to give Congress more time to prevent the payment cut. That hold expired yesterday, but CMS has indicted that any claims processed at the reduced rates will be reprocessed automatically with no action required of physicians.