Medicare Compliance & Reimbursement

CMS realizes importance of paying more attention to primary care.

Family physicians and similar specialties can look forward to a proposed seven percent hike in Medicare pay rates in 2013, as well a potential pay increase for patients' after hospitalization care.

Sneak Peek: A glimpse of how the Centers for Medicare & Medicaid Services (CMS) proposes to calculate Medicare pay rates for 2013 came when the Medicare Physician Fee Schedule for 2013 was published in the July 30 Federal Register.

Primary Care Gets a Raise

In addition to the seven percent payment increase for family physicians, the proposal includes a five percent payment increase for pediatricians and internal medicine physicians.

Rationale: "Helping primary care doctors will help improve patient care and lower health care costs long term," CMS Acting Administrator Marilyn B. Tavenner said in a July 6 statement.

As many family medicine groups know, Congress voted earlier this year to postpone a 27 percent Medicare payment cut that was supposed to occur in 2012. Unfortunately, the 2013 Fee Schedule projects that cuts for most specialties will be just as steep on January 1, 2013, unless Congress and the President again intervene. Practices will have to play a waiting game and hope that legislators once again halt the decreases resulting from current law.

Hospital Transition Pay Could Be in Your Future

Physicians who provide care following a patient's hospital discharge could also be looking at a healthier bottom line next year.

"The proposal calls for CMS to make a separate payment to a patient's community physician or practitioner to coordinate the patient's care in the 30 days following a hospital stay," CMS says.

"The proposed rule also asks for public comment on how Medicare can better recognize the range of services community physicians and practitioners provide as part of treating patients, either through face-to-face services in the office or coordinating care outside the office when the patient does not see the physician," the CMS statement continues.

Timeline: CMS accepted public comment on the proposed rule through September 4 and now will begin work on the final rule, which is due on or about November 1. For more information on the proposed rule, visit the CMS web site at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1590-P.html.