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Medical Coding News Archives

Primary Care and Complex Chronic Care Management: A Focus of Physician Payment Rule

July 18, 2013:

Deborah Hall, Clinical/Technical Editor

As usual, the Centers for Medicare and Medicaid Services has proposed a cut in physician payment for the upcoming fiscal year. For the past few years, Congress has intervened to head off drastic cuts in physician payments, though such action is not by any means guaranteed.

CMS placed the proposed rule for the 2014 Medicare physician fee schedule (MPFS) on display July 8. Under the rule, the 2014 conversion factor—the dollar value by which the relative values are multiplied to determine the reimbursement rate—would be $26.8199 after a budget-neutrality adjustment. The current-year conversion factor after the budget neutrality adjustment is $35.6653. This means that the proposed conversion factor would result in a significant loss of revenues for physicians.

The negative update is a result of the sustainable growth rate (SGR), a statutory formula used to compute the update to physician payment that CMS cannot change. In March 2013, CMS estimated that the physician fee schedule would be updated by –24.4 percent as a result of this formula. In past years emergency legislation by Congress has prevented the negative update until such time as a permanent address to the flaws in the SGR could be developed.

Depending on the specialty, practices could see anywhere from a 26 percent decrease (independent laboratory) in Medicare payments to a 4 percent increase (nurse anesthetist) after all the revisions to the fee schedule are accounted for. Most physician practices would see a decrease of between 1 and 3 percent.

The conversion factor published in the final rule could be different, and Congress could take action after the final rule is published, as has happened in previous years. Such intervention cannot be taken for granted, however, so it is important for practices to remain aware of updates from CMS on the status of the fee schedule so that they know what their reimbursement may be for the upcoming year.


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