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Supero Healthcare Solutions Provider Enrollment and Credentialing Blog

Provider Enrollment - 2013 Medicare Physician Fee Schedule Issued

Posted by Brian Agnew on Tue, Nov 27, 2012 @ 19:11 PM

Provider Enrollment News From Supero Healthcare Solutions:


The CY 2013 PFS final rule with comment period was placed on display at the Federal Register on November 1, 2012. The conversion factor dropped from $34.0376 in 2012 to $25.0008. Add this to the changes in the RVU values themselves and we could have a real mess on our hands. Physicians are on edge to see what might happen to them with regards to their reimbursement via our beloved government sponsored program: Medicare. 

Some of the winners of the new fee schedule include family medicine doctors who , with changes in care coordination payment and some other changes in the rule, stand to see a 7% increase and other primary care providers will see a 3% - 5% increase.  However, this will only happen if Congress averts the statutorily required reduction in Medicare’s physician fee schedule.  A list of how each specialty is impacted is listed by the AMA here. 

In announcing the Final Rule, the Centers for Medicare and Medicaid Services (CMS) said that the final rule with comment period also includes a statutorily required 26.5 percent across-the-board reduction to Medicare payment rates for more than 1 million physicians and non-physician practitioners under the Balanced Budget Act of 1997’s Sustainable Growth Rate (SGR) methodology.

Nothing new to share here, but Congress has overridden the required reduction every year dating back to 2003. The Administration is committed to fixing the SGR update methodology and ensuring these payment cuts do not take effect.  It is highly likely that the reduction won't happen in 2013 either.  As always, everyone is put on edge and nothing happens.  We can only hope that we are not around when something does.  The unfortunate problem is that wherever Medicare rates end up, many of the commercial payors who use Medicare as a basis for reimbursement will likely follow suit with cuts, but it is doubtful they would impliment any increases. Most payors are looking for reducing reimbursement rather than making increasing fees that are paid out to their providers.  

Visit CMS' website to see the final rule with comment period here.  Additionally you can read the CMS fact sheet here.  The comment period closes on December 31, 2012.

If you are seeking assistance with Medicare Provider Enrollment.  Please click here for more infomation.  

Brian Agnew is President of Supero Healthcare Solutions a leading practice management company focused on provider enrollment and credentialing services for physicians and other healthcare providers.


Topics: Provider Enrollment, Payor Contracting, Payor Credentialing, Provider Enrollment Services, Physician Credentialing, Medical Credentialing, Provider Credentialing, Insurance Credentialing, Medicare Provider Enrollment