2013 Proposed Medicare Physician Fee Schedule

HISThe following is an industry update, recently sent to current HIS radiology clients:

In recent weeks, which you may or may not be aware of, The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed a new Medicare Physician Fee Schedule (MPFS) for 2013 that will reduce payments to radiologists by 4% and radiation oncologists by 15%.  The proposed cuts would be made to pay for a 7% increase in payments to family physicians and a 3-5% increase to other primary care physicians.  In simple terms, decreases in payments for radiology services, equal increases in payments for others. Please keep in mind that CMS typically starts out high with proposed cuts, but most often these cuts are drastically reduced, if not postponed.   

CMS’ proposal would also apply the multiple procedural payment reduction (MPPR) of 25% to the professional component and technical component of advanced imaging procedures when one or more physicians in the same group practice furnish services to the same patient in the same session on the same day. The reductions had been finalized in a 2012 final rule, but “operational limitations” prevented it from being implemented, CMS says in the proposed rule. 

As it stands now, the rule for CT, MRI, and UL states that if the same physicians read a combination of the above studies, the second study will be reduced by 25%.  The difference in 2013 will be that CMS will recognize the entire radiology group as one physician.  Current work flows of physicians reading a specific modality, have allowed physicians to work around this reduction and receive full pay.  This will no longer be the case.

The proposed cuts, have caused great stir in the Radiology community, and rightfully so. ACR is calling the proposed setbacks “extreme” and “unnecessary”, and plans to launch an effort to get its members to lobby against the proposed cuts. 

As always, HIS will continuously monitor this evolving situation and with the help of our business partners and industry resources keep our clients informed.  To reiterate, that this information is very premature and that historically Medicare typically starts off high in its cut estimates, then retracts.  Yet, Although this is still in the ‘proposal’ phase, it is something to become familiar with and become aware of the future potential impacts.

 Questions? Feel free to contact us or leave a comment below.