Practices To Be Prepared For A 26.5% Drop In Medicare Pay In The Coming Year!

Some complex repair codes will face severe cuts in 2013.

As the New Year approaches practices wait anxiously to see if there are any chances of them losing money. This year The Centers for Medicare & Medicaid Services (CMS) has offered some relief in the 2013 MPFS including new transitional care management codes and associated payment but at the same time has included a 26.5 percent conversion factor cut that could impact practices across-the-board if Congress doesnt act to reverse it before Jan. 1.

Since there was absence of Congressional action, an overall reduction of 26.5 percent will be imposed for the conversion factor that will be used to calculate payment for physicians services on or after January 1, 2013.

Some practices that will get affected is Neurology as neurologists will see a 7 percent cut to their total Medicare reimbursement in 2013, while pathologists will face 6 percent pay cuts. Independent laboratories will see a 14 percent combined impact due to the potentially misvalued care initiative, as has been revealed by The Centers for Medicare & Medicaid Services.

If Congress doesnt act to increase the conversion factor there could be additional cuts. According to the final rule, practitioners of dermatology are projected to see a 0 percent combined impact to their reimbursements. According to the American Academy of Dermatology, the relative value units (RVUS) were maintained at almost the same payment levels for most of the codes in the complex repair code family. But the final 2013 fee schedule included a reduction to some Dermatology codes like CPT codes 13152 with the description: Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm by 13 percent, and CPT codes 13132 with the description: Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm by 16 percent as a result of the cut in physician work Relative Value Units.

For CPT codes 13152, the physician work Relative Value Units was cut by 23.08 percent and the practice expense Relative Value Units was cut by 4.4 percent; whereas for CPT codes 13132 the physician work Relative Value Units was cut by 27.36 percent and the practice expense Relative Value Units was cut 7.59 percent respectively.

Amongst other specialties mostly primary care is expected to see pay rises under the proposal. CMS has finalized a seven percent increase for family practitioners, a four percent boost for internal medicine physicians, and a five percent raise for geriatricians thereby causing some relief to some practices.

by: ashutosh

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