Medicare Compliance & Reimbursement

The most widespread changes throughout CPT^® 2013 -- the switch to more inclusive or provider-neutral language -- shouldn’t be difficult for physician practices to put into place.

"The concepts are pretty straightforward," said Richard Duszak, Jr., M.D., an AMA CPT® Editorial Panel member and practicing radiologist. "There’s been an evolution in CPT® for how codes report services by non-physicians."

Result: Hundreds of codes were revised for 2013 to include "provider neutral language." Codes throughout the book have replaced designations of "physician" with "individual" or "qualified health care provider."

Exception: A few codes retained the "physician" language, such as those related to skilled nursing facility admissions, because regulations require that a physician admit the patient.

"CPT® is not the turf police," Duszak said. "We’re focusing on the services provided and recognize that sometimes professionals other than physicians are qualified to provide some services. As a nationally recognized reporting system, it’s important for CPT® to maintain provider neutrality."

Watch Your Mail for PCIP Checks

CMS will continue the primary care incentive program (PCIP) through 2015. The agency distributed approximately $560 million to providers in 2011 through the PCIP, according to Kathy Bryant, deputy director of the department of physician services at CMS.

Bonus: Providers don’t need to apply for participation. CMS reviews providers’ records and automatically sends payments to those who qualify.

Big caution: "The main thing you need to worry about is your physician’s Medicare specialty designation," Bryant cautioned. "He must have the primary care specialty designation in CMS records, or he won’t receive payments. He may have switched from ER to primary care years ago, but he won’t get paid if his CMS designation still says ER."