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Pediatric Coding Alert

Pediatric Payment:

Proposed 2013 Fee Schedule Offers Five Percent Raise for Pediatricians

Published on Tue Jul 31, 2012

Plus: Additional payments for hospital transitions could boost your income if finalized.

CMS--the governing body that oversees Medicare and Medicaid--is offering an innovative new approach to medicine that offers some good news for pediatricians if it's finalized by the end of this year.

On July 6, CMS released its proposed Medicare Physician Fee Schedule for 2013. The 760-page document, which will be published in the July 30 Federal Register, offers a glimpse into how the agency would calculate Medicare pay rates for the coming year. Although pediatricians do not see Medicare patients, the Fee Schedule is important because many private payers follow Medicare's lead when setting rates.

Five Percent Pay Raise Would Benefit Pediatricians

CMS is proposing a five percent payment increase for pediatricians and internal medicine physicians, and a seven percent increase for family practitioners. "Helping primary care doctors will help improve patient care and lower health care costs long term," said CMS Acting Administrator, Marilyn B. Tavenner in a July 6 statement.

As many pediatric practices are aware, Congress voted earlier this year to eliminate a 27 percent Medicare payment cut that was supposed to kick in for 2012. Unfortunately, the 2013 Fee Schedule projects that they will be just as steep, so practices will have to play a waiting game once more next year and hope that legislators once again halt such cuts.

Proposal Would Pay for Hospital Transitions

If your pediatrician spends a significant amount of time providing care following a hospital discharge, you might see extra pay for that service in 2013 if the proposal is finalized.

"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," 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."

Resource: The proposal will be published in the July 30 Federal Register, and is viewable until that time at www.ofr.gov/%28X%281%29S%284r2fvkvw0smg0be3dnhpen3p%29%29/OFRUpload/OFRData/2012-16814_PI.pdf. For a copy of the proposal via email, contact editor Torrey Kim, CPC, CGSC at torreyk@codinginstitute.com.

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