Healthcare Update: CMS Releases Five Rules Affecting Provider Payments


    On November 1 and 2, the Centers for Medicare & Medicaid Services (CMS) released a flurry of rules dealing with healthcare provider payments for fiscal year 2013 and other matters. One rule, released on November 1, sets forth changes to the Medicare physician fee schedule. The other two rules released on November 1 address payments under Medicaid and the Medicare hospital outpatient and ambulatory surgical care center payment systems. The two rules released on November 2 address payment rates for home health providers and dialysis facilities, among other things.

    The Medicare physician fee schedule rule includes the 26.5% reduction to Medicare payment rates that is required under the Sustainable Growth Rate (SGR) methodology. However, it is anticipated that Congress will override these cuts with a temporary “doc fix” bill as it has done every year since 2003. As we reported last month, physicians’ organizations are urging Congress to implement a permanent replacement for the SGR formula. In a fact sheet about the new rule, CMS stated, “The Administration is committed to fixing the SGR update methodology and ensuring these payment cuts do not take effect. Predictable, fiscally-responsible physician payments are essential for Medicare to sustain quality and lower health care costs over the long-term.”

    The fee schedule rule also continues the implementation of the physician value-based payment modifier; outlines the next steps to enhance the Physician Compare website; expands access to services provided by Certified Registered Nurse Anesthetists; allows Medicare to pay for portable x-rays ordered by nurse practitioners, physician assistants and other non-physician practitioners; and requires a face-to-face encounter as a condition of payment for certain durable medical equipment (DME) items. The final rule is scheduled to be published in the Federal Register on November 16, 2012, and comments from the public will be accepted through December 31, 2012. Most provisions of the rule will be effective January 1, 2013, but the DME provisions will be effective July 1, 2013.

    Click here for a complete copy of the Update.

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