CMS Issues CY 2013 Proposed Physician Fee Schedule Rule
July 12: AOTA Analysis: 2013 Fee Schedule Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule entitled, “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013.” The proposed rule may be found on the Electronic Federal Inspection Desk, available here: http://www.ofr.gov/OFRUpload/OFRData/2012-16814_PI.pdf.
The proposed rule includes a plan to collect data on patient function next calendar year to inform how Medicare pays for occupational therapy as well as physical and speech-language pathology services. According to CMS, the proposal also includes a plan to increase payments to family physicians by approximately 7% and other practitioners providing primary care services between 3% and 5%. The increase in payment to family practitioners is part of the proposed rule that would update payment policies and rates under the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2013.
For CY 2013, CMS is also proposing for the first time to explicitly pay for the care required to help a patient transition back to the community following a discharge from a hospital or nursing facility. The proposals 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 or skilled nursing facility (SNF) stay. In addition, the proposed rule 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.
The proposed rule also includes:
- A proposal to include additional Medicare-covered preventive services on the list of services that can be provided via an interactive telecommunications system;
- A proposal to implement a durable medical equipment (DME) face-to-face requirement as a condition of payment for certain high-cost Medicare DME items;
- A proposal to apply a multiple procedure payment reduction (MPPR) policy (such as the one currently applied to outpatient occupational therapy services) to the technical component of the second and subsequent cardiovascular and ophthalmology diagnostic services furnished by the same doctor to the same patient on the same day;
- A request for public comments on payment for advanced diagnostic molecular pathology services;
- A proposal to revise a regulation that only allows Medicare to pay for portable x-rays ordered by an MD or DO. The revised regulations would allow Medicare to pay for portable x-ray services ordered physicians and non-physician practitioners acting within the scope of their Medicare benefit and state law;
- A proposal to clarify when Medicare will pay for interventional pain management services provided by Certified Registered Nurse Anesthetists (CRNAs) when permitted by State law. This proposal will foster access to pain management services in areas where states have determined that CRNAs may provide these services.
AOTA is currently analyzing the proposed rule and its implications for occupational therapy. Comments are due on September 4, 2012, and a final rule will be issued by November 1, 2012. AOTA will submit comments to CMS and welcomes your thoughts at email@example.com.