Due to recent legislative changes, many providers will see increased claims reimbursement in 2013. Below are the details of three areas that will be effected.- Increased Medicaid Payments to Primary Care Physicians:
The National Quality Strategy, required by The Affordable Care Act of 2010,
is a national plan to improve the delivery of health care services,
patient health outcomes, and population health. Three goals are used to
guide and assess local, state, and national efforts to improve health
and the health care delivery system: better care, healthy people/healthy
communities, and affordable care.
Medicaid and CHIP currently provide health
coverage to nearly 60 million Americans, including children, pregnant
women, parents, seniors and individuals with disabilities. Medicaid
payment increases are planned for certain primary care services provided
to Medicaid beneficiaries in 2013 and 2014. This is an attempt to draw
more primary care providers into the program in order to handle the
inevitable increase in demand as enrollment is expected to expand by
somewhere between 10-16 million individuals starting at the beginning of
2014.
Reimbursement will be raised to payment
rates that match Medicare for specific services provided by a physician
with a primary specialty designation of family medicine, general
internal medicine, or pediatric medicine. The services subject to the
increase are evaluation and management services represented by procedure
codes in the category designated Evaluation and Management in the
Healthcare Common Procedure Coding System and services related to
immunization administration for vaccines and toxoids for CPT codes
90465, 90466, 90467, 90468, 90471, 90472, 90473, and 90474.
Higher payments and increased provider participation are key factors in implementing the National Quality Strategy.
- Increased Medicare payments to Primary Care Physicians:
The Centers for Medicare & Medicaid
Services (CMS) issued a final rule with comment period on November 1,
2012 for Medicare’s payments for physician fees for 2013. It includes a
new policy to pay a patient’s physician or practitioner to coordinate
the patient’s care in the 30 days following a hospital or skilled
nursing facility stay. The changes in care coordination payment and
other changes in the rule are expected to increase payment to family
practitioners by seven percent—and other primary care practitioners
between three and five percent—if Congress averts the statutorily
required reduction in Medicare’s physician fee schedule.
This new physician fee rule is part of the drive to reward savings and foster collaboration amongst primary care providers.
The final rule with comment period can be viewed at:
The rule will be published on November 16,
2012. It will take effect January 1, 2013 with a comment period that
closes on December 31, 2012.
- Increased Medicare Payments for Outpatient Hospital Services:
The Centers for Medicare & Medicaid
Services (CMS) finalized the Hospital Outpatient Prospective Payment
System (OPPS) rule on November 1, 2012, updating Medicare payment
policies and rates for hospital outpatient services beginning January 1,
2013.
The final OPPS/ASC rule with comment
period affects hospital outpatient departments in more than 4,000
hospitals, including general acute care hospitals, inpatient
rehabilitation facilities, inpatient psychiatric facilities, long-term
acute care hospitals, children’s hospitals, and cancer hospitals, and
approximately 5,000 Medicare-participating ASCs.
Rates and policies set in the calendar
year (CY) 2013 final rule with comment period will increase payment
rates for hospital outpatient departments by 1.8 percent. The increase
is based on the projected hospital market basket—an inflation rate for
goods and services used by hospitals—of 2.6 percent, minus 0.8 percent
in statutory reductions, including a 0.7 percent adjustment for
economy-wide productivity and a 0.1 percentage point adjustment required
by statute.
Total payments to hospitals under the OPPS in CY 2013 will be approximately $48.1 billion.
To view the CY 2013 OPPS and ASC payment system final rule with comment period and changes to the QIO program, please see:
The rule will be published on November 15,
2012. It will take effect January 1, 2013 with a comment period that
closes on December 31, 2012.
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