Sequester Kicks In;
However, 2% Medicare Cut Is Delayed

In August of 2011 Congress passed and President Obama signed the Budget Control Act, which established across the board automatic budget cuts. These automatic cuts, known as the budget sequestration, took effect on Friday March 1, 2013 and include a 2% Medicare payment decrease. However, due to details of the legislation, the physician payment reductions are not scheduled to take effect until April 1, 2013. In addition to the sequester, there are other significant physician reimbursement changes in 2013, which are discussed in the LogixHealth 2013 Physician Update Newsletter.

CMS Final Rule and CPT Changes

The 2013 Medicare Physician Fee Schedule Final Rule, governs payment rates, as well as other critical reimbursement issues, for dates of service beginning on January 1, 2013. The Final Rule also addresses statutory requirements as directed by the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act). The rule, which is published in the November 25, 2012 Federal Register, can be found at the LogixHealth website.

2013 Conversion Factor

At the conclusion of 2012, the Medicare Conversion factor (the amount Medicare pays per RVU) was set at $34.0376. The 2013 Rule is still governed by the SGR (Sustainable Growth Rate) formula which since 1997 has mandated increasingly draconian cuts to physician payments, resulting in year after year eleventh hour Congressional rescues with short term fixes. The 2013 Final Rule published a conversion factor of $25.008, representing a 26.5% cut to physician payments, which yet again was patched by Congress with a short-term fix.

2013 RVUs for ED E/M Services

Each year, the Rule publishes updated RVUs for physician services. For 2013, the Work RVUs for Emergency Medicine services remain unchanged. The Total RVUs associated with ED E/M services 99281-99285 and 99291 will experience only second decimal point changes, driven by small changes predominantly in Practice Expense. The CMS-published specialty-specific impact analysis states that Emergency Medicine will experience a 0% decrease in overall RVU values for 2013, meaning our RVUs are essentially unchanged. Of note, this 0% decrease does not consider any change to the conversion factor. Read the complete LogixHealth 2013 Physician Update Newsletter.

"The process of bundling like procedures, termed MPPR, has been expanded and can trigger a 20-25% decrease in reimbursement."
- Elijah Berg, M.D., CEO of LogixHealth

Read the complete LogixHealth 2013 Physician Update Newsletter

Or visit
www.logixhealth.com