Thursday, CMS issued two final regulations updating Medicare payment rates and policies in calendar year (CY) 2013 for services furnished by physicians, other practitioners, and a rule updating payment rates and policies for hospital outpatient departments and ambulatory surgical centers.

The Medicare Physician Fee Schedule was issued with a comment period. It includes the statutorily mandated 26.5 percent reimbursement cut. However, CMS anticipates that Congress will act, as it has done before, to reverse the payment reductions. Should Congress not act in time, CMS has in the past held claims as Congress hashed out a temporary physician fee "fix." In addition, the rule includes, for the first time, a new policy to pay a patient's physician or practitioner to coordinate the patient's care in the 30 days following a hospital or skilled nursing facility stay. In addition the rule includes:

  1. Implementation of the physician value-based payment modifier by phasing in application of the modifier and enabling physicians in larger groups to choose how to participate. The value modifier provides differential Medicare payments to physicians based on comparison of the quality of care furnished to beneficiaries and the cost of care.
  2. Changes to the Physician Quality and Reporting System (PQRS) and the Electronic Prescribing (eRx) Incentive Program, the two quality reporting programs applicable to the Medicare Physician Fee Schedule (MPFS), and updates to the Medicare Electronic Health Records (EHR) Incentive Pilot Program. These changes will simplify reporting and align the various programs' quality reporting approaches so they support the National Quality Strategy.
  3. Next steps to enhance the Physician Compare website, including posting names of practitioners who as part of the Million Hearts campaign, successfully report measures to prevent heart disease.
  4. Expanding access to services that can be provided by nonphysician practitioners. The rule allows Certified Registered Nurse Anesthetists (CRNAs) to be paid by Medicare for providing all services that they are permitted to furnish under state law. This change will allow Medicare to pay CRNAs for services to the full extent of their state scope of practice. The rule also allows Medicare to pay for portable x-rays ordered by nurse practitioners, physician assistants and other nonphysician practitioners.
  5. A pathway for paying for molecular pathology services -- the next innovation of clinical laboratory tests that will foster the development of personalized medicine. These tests will be paid under the Clinical Laboratory Fee Schedule, with 2013 payment set by the gap-filling method.
  6. A face-to-face encounter requirement as a condition of payment for certain durable medical equipment (DME) items for orders written on or after July 1, 2013.

To read the final CY 2013 Medicare Physician Fee Schedule (MPFS) rule with comment period, please visit the Office of the Federal Register website.