2013 Medicare Physician Fee Schedule – Anesthesia

11/14/2012- On November 1, 2012, CMS released the 2013 Medicare Physician Fee Schedule (MPFS) final rule with comment, which modified or finalized the proposed fee schedule rule released in July 2012.

Here are some of the general provisions of the 2013 MPFS, followed by provisions specific to anesthesia services

 

SGR and the 2013 Fee Adjustments

If Congress does not intervene, the SGR (sustainable growth rate) reduction for 2013 will be 26.5%, which results in the conversion factor reduction of the same amount to all medical services under MPFS.  The 2013 conversion factor (CF) will be $25.0008, down from the 2012 CF of $34.0376.

The actual payment adjustment for provider services may be more or less than the SGR, depending on other changes in code values contained in this final rule such as:

  • Payments to primary care providers would increase, primarily based on the new transition care codes, but also because of the application of the last year of the 4-year transition to new Practice Expense (PE) RVUs using the new Physician Practice Information Survey (PPIS) data
  • Several types of providers will see decreases in MPFS payments as a result of the:
    • potentially misvalued codes initiative, and
    • redistributions to pay for the payment increase for primary care services, particularly the 7% family practice rate increase

The impact of the 2013 fee changes, separate from any SGR reduction,  for anesthesia services from 2012 to 2013 is projected to be as follows:

Anesthesiology 3%
Interventional Pain Mgmt 1%
Nurse Anes/Anes Asst 1%

 

Sequestration, if continued by Congress, would place an additional reduction to Medicare rates, on top of the SGR, by another 2%.

 

Value Based modifier

CMS will continue with the implementation of a physician value-based payment modifier, to be phased in over three years from 2015-2017.  This modifier will provide differential Medicare payments to physicians based on comparison of the quality and cost of care provided to beneficiaries.

Proposed Rule:  applied the value modifier to groups of physicians with 25 or more eligible professionals.

Final Rule:  The final rule changed the group size to 100 or more EPs.   CMS states the change was made to gain experience with the methodology and approach before expanding it to smaller groups.

The rule also provides an option for these groups of physicians to choose how the value modifier is calculated based on whether they participate in the PQRS  (Physician Quality Reporting System) Incentive Program.

 

PQRS & eRx  Incentive Programs

The rule makes changes to the PQRS and E-prescribing (eRx) programs and updates the EHR Incentive Pilot program in order to align the programs to enable simplified reporting and support of the National Quality Strategy (NQS).

Some of the basic PQRS provisions are:

  • Reporting period will be based on a 12-month reporting time frame
  • Bonus payment will be 0.5%
  • Calendar year 2013 will be used as the reporting period for the 2015 PQRS payment adjustment of 1.5%
  • Participants in the PQRS program will continue to report a minimum of 3 individual measures or 1 group measure:
    • via claims-based reporting on 50% or more of all eligible Medicare patients, or
    • via registry reporting on 80% or more of all eligible Medicare patients

The rule also describes the next steps to enhance the Physician Compare website.

We will publish more on the specific changes to these incentive programs in future newsletters.

 

ANESTHESIA

 

CRNAs and Pain Management

Proposed rule:  Establish a Medicare standard for anesthesia and related care services that can be furnished and billed by Certified Registered Nurse Anesthetists (CRNAs). CMS proposed to add the following language to its carrier manual, “Anesthesia and related care includes medical and surgical services that are related to anesthesia and that a CRNA is legally authorized to perform by the State in which the services are furnished.”  The standard would be consistent with existing policy that recognizes state scope of practice laws regarding services that can be furnished and billed by other non-physician practitioners.

Final Rule:  Finalized the proposed rule with modification by defining the statutory benefit category for CRNAs, which is specified as “anesthesia and related care,” as “those services that a certified registered nurse anesthetist is legally authorized to perform in the state in which the services are furnished.” By this action, CMS is defining the Medicare benefit category for CRNAs as including any services the CRNA is permitted to furnish under their state scope of practice. This action results in CRNAs being treated similarly to other advanced practice nurses for Medicare purposes. This policy is consistent with the Institute of Medicine’s recommendation that Medicare cover services provided by advanced practice nurses to the full extent of their state scope of practice.

Tags: Medical Billing, Physician Fee Schedule, SGR and Medicare Fee Schedule

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